Provider Demographics
NPI:1023143013
Name:LEVINE, LARRY MARTIN (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:MARTIN
Last Name:LEVINE
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 1:501 NEW RD
Mailing Address - Street 2:GROVELAND CENTER
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2064
Mailing Address - Country:US
Mailing Address - Phone:609-927-4526
Mailing Address - Fax:
Practice Address - Street 1:501 NEW RD
Practice Address - Street 2:GROVELAND CENTER
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2064
Practice Address - Country:US
Practice Address - Phone:609-927-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00388800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ463860OtherAETNA
NJ30207OtherGROUP VISION ASSOCIATES
NJ0089709000OtherAMERIHEALTH
NJ31685OtherDAVIS VISION
NJNJ3888OtherEYE MED
NJ1086683OtherHORISON N.J. HEALTH
NJ19532OtherAMERIGROUP
NJ1956604Medicaid
NJ463860OtherAETNA
NJU26635Medicare UPIN