Provider Demographics
NPI:1770626202
Name:NORMA J. LEVINGSTON, O.D., INC.
Entity type:Organization
Organization Name:NORMA J. LEVINGSTON, O.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LEVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-238-9696
Mailing Address - Street 1:3257 S WHITE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-4056
Mailing Address - Country:US
Mailing Address - Phone:408-238-9696
Mailing Address - Fax:408-238-4067
Practice Address - Street 1:3257 S WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4056
Practice Address - Country:US
Practice Address - Phone:408-238-9696
Practice Address - Fax:408-238-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5558T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0055581Medicare PIN