Provider Demographics
NPI:1710068184
Name:LEVINE, LISA ROSEMOND (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ROSEMOND
Last Name:LEVINE
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:31 FLINT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-3016
Mailing Address - Country:US
Mailing Address - Phone:610-775-1241
Mailing Address - Fax:
Practice Address - Street 1:1665 STATE HILL RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1900
Practice Address - Country:US
Practice Address - Phone:610-373-2830
Practice Address - Fax:610-655-8805
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30698Medicare UPIN