Provider Demographics
NPI:1265575989
Name:LEVY, MICHELE (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2770
Mailing Address - Country:US
Mailing Address - Phone:401-315-0002
Mailing Address - Fax:401-388-8395
Practice Address - Street 1:55 BEACH ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2770
Practice Address - Country:US
Practice Address - Phone:401-315-0002
Practice Address - Fax:401-388-8395
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICODTG00734152WL0500X, 152WP0200X, 152WX0102X, 152WC0802X, 152W00000X
CTCT2257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152W00000XEye and Vision Services ProvidersOptometrist