Provider Demographics
NPI:1184685729
Name:LEVINE, KENNETH BENSON (OD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:BENSON
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 1:279 CAMBRIDGE STREET # 4
Mailing Address - Street 2:BURLINGTON EYE CARE
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803
Mailing Address - Country:US
Mailing Address - Phone:781-272-7733
Mailing Address - Fax:781-272-5740
Practice Address - Street 1:279 CAMBRIDGE STREET # 4
Practice Address - Street 2:BURLINGTON EYE CARE
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803
Practice Address - Country:US
Practice Address - Phone:781-272-7733
Practice Address - Fax:781-272-5740
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2745152W00000X
MAMA2745152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW16224OtherBLUE CROSS BLUE SHIELD
MA0336009Medicaid
MA9281808OtherPHCS
MA110108180AMedicaid
MAMA2745OtherAETNA
MA04-2677792OtherUNITED HEALTHCARE INS
MA56190OtherOPTICARE
MAAS78783190001OtherCIGNA HEALTH CARE
MAMA2745OtherEYEMED