Provider Demographics
NPI:1205970605
Name:LEVITIN, MARTIN D (OD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:D
Last Name:LEVITIN
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 1:3469 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1000
Mailing Address - Country:US
Mailing Address - Phone:614-235-2392
Mailing Address - Fax:614-235-2756
Practice Address - Street 1:3469 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1000
Practice Address - Country:US
Practice Address - Phone:614-235-2392
Practice Address - Fax:614-235-2756
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3746152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2200260OtherUNITED HEALH CARE OF OHIO INC
OH300013755026OtherCARESOURCE
OHLE16214OtherSPECTERA
OH000000224734OtherANTHEM BLUE CROSS AND BLUE SHIELD OF OHIO
OH0577246Medicaid
OH2649129Medicaid
OH300013755OtherCIGNA
OH300013755OtherAETNA
OH2649129Medicaid
OH2649129Medicaid
OH0593672Medicare PIN
OH4393040001Medicare NSC