Provider Demographics
NPI:1811348121
Name:DORFMAN-LEVY, ELINA (OD)
Entity type:Individual
Prefix:DR
First Name:ELINA
Middle Name:
Last Name:DORFMAN-LEVY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELINA
Other - Middle Name:
Other - Last Name:DORFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 MEDICAL CENTER BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3955
Mailing Address - Country:US
Mailing Address - Phone:610-874-5261
Mailing Address - Fax:
Practice Address - Street 1:2 W BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3740
Practice Address - Country:US
Practice Address - Phone:610-874-5261
Practice Address - Fax:610-874-0318
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003193152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist