Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4028 | MA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 4028 | MA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 4028 | MA |
NPI | 1013977685 |
---|---|
Provider Name | Dr. Paul E Levine |
First Address | Southborough, MA 01772-2114 |
Second Address | Southborough, MA 01772-2114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 18/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0700347 | (05) | MA |
U67948 | (02) | MA |