Provider Demographics
NPI:1912048885
Name:LEVIN, MINDABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:MINDABETH
Middle Name:
Last Name:LEVIN
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 1:8220 WALNUT HILL LN STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4403
Mailing Address - Country:US
Mailing Address - Phone:214-691-8000
Mailing Address - Fax:
Practice Address - Street 1:8220 WALNUT HILL LN STE 700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4403
Practice Address - Country:US
Practice Address - Phone:214-691-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9946T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 2583Medicare PIN