Provider Demographics
NPI:1770773301
Name:GRUNSTEIN, LEV LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:LEV
Middle Name:LAWRENCE
Last Name:GRUNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 POLULANI DR
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1556
Mailing Address - Country:US
Mailing Address - Phone:610-909-4555
Mailing Address - Fax:
Practice Address - Street 1:450 HOOKAHI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1474
Practice Address - Country:US
Practice Address - Phone:808-877-3984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 109055207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G334240Medicaid
CADF700ZMedicare PIN