Provider Demographics
NPI:1811242787
Name:MANSFIELD, LEVI CHRISTOPHER (OD)
Entity type:Individual
Prefix:DR
First Name:LEVI
Middle Name:CHRISTOPHER
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-5601
Mailing Address - Country:US
Mailing Address - Phone:270-845-9015
Mailing Address - Fax:
Practice Address - Street 1:111 N FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-5601
Practice Address - Country:US
Practice Address - Phone:270-845-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1898DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
K065740Medicare PIN