Provider Demographics
NPI:1730222704
Name:LEVINE, FLORA (OD)
Entity type:Individual
Prefix:
First Name:FLORA
Middle Name:
Last Name:LEVINE
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 1:1570 STEVENSON RD
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557
Mailing Address - Country:US
Mailing Address - Phone:718-743-5055
Mailing Address - Fax:
Practice Address - Street 1:25913 UNION TPKE
Practice Address - Street 2:GLEN OAKS FAMILY VISION
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1248
Practice Address - Country:US
Practice Address - Phone:718-347-7470
Practice Address - Fax:718-347-7493
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV6241152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C198B2Medicare PIN
05123GMedicare PIN
NY89783Medicare UPIN