Provider Demographics
NPI:1437579463
Name:LEVINSON, STUART D
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:D
Last Name:LEVINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8788 BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-4467
Mailing Address - Country:US
Mailing Address - Phone:561-413-2492
Mailing Address - Fax:561-413-2523
Practice Address - Street 1:8788 BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-4467
Practice Address - Country:US
Practice Address - Phone:561-413-2492
Practice Address - Fax:561-413-2523
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5286156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician