1417924648 NPI number — DR. CHRISTINA J. LEVI O.D.

Table of content: (NPI 1376681627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417924648 NPI number — DR. CHRISTINA J. LEVI O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVI
Provider First Name:
CHRISTINA
Provider Middle Name:
J.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417924648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 E BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62002-6220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-462-9818
Provider Business Mailing Address Fax Number:
800-432-6004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 E BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62002-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-462-7611
Provider Business Practice Location Address Fax Number:
800-432-6004
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  046-009003 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: TO3352 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 126315 . This is a "BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 217290 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43981 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: OPO694 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22-01500 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 12448 . This is a "OPTICARE MEDICARE COMPLET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 046-009003 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1417924648 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 479374 . This is a "HEALTLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126220 . This is a "BLUE CROSS BLUE SHIELD MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 316017813 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410048079 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 316017805 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com