Provider Demographics
NPI:1578506663
Name:LEVY, ROBERT I (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:LEVY
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 1:5825 DORTON LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3441
Mailing Address - Country:US
Mailing Address - Phone:804-270-7303
Mailing Address - Fax:
Practice Address - Street 1:12244B W BROAD ST
Practice Address - Street 2:SUITE 128
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1062
Practice Address - Country:US
Practice Address - Phone:804-360-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA268736OtherANTHEM BC/BS
VAP00432899OtherRAILROAD MEDICARE
VAP00432899OtherRAILROAD MEDICARE
VAU06046Medicare UPIN