Individual
DR. JACK LEVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2064 SENECA ST, BUFFALO, NY 14210-2343
(716) 822-1515
Mailing address
120 MEYER RD, #523, BUFFALO, NY 14226-1046
(716) 834-6399
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV002844-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00610619
—
NY
Enumeration date
10/19/2006
Last updated
07/08/2007
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