Basic Information
| Provider Information | |||||||||
| NPI: | 1417924648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVI | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620026220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184629818 | ||||||||
| FaxNumber: | 8004326004 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620022417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184627611 | ||||||||
| FaxNumber: | 8004326004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 04/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046-009003 | IL | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | TO3352 | MO | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 126315 | 01 | MO | BLUE CHOICE | OTHER | 217290 | 01 | GHP | OTHER | 43981 | 01 | DAVIS VISION | OTHER | OPO694 | 01 | EYEMED | OTHER | 22-01500 | 01 | MO | UNITED HEALTHCARE | OTHER | 12448 | 01 | OPTICARE MEDICARE COMPLET | OTHER | 046-009003 | 05 | IL | MEDICAID | 1417924648 | 01 | NPI | OTHER | 479374 | 01 | HEALTLINK | OTHER | 126220 | 01 | MO | BLUE CROSS BLUE SHIELD MO | OTHER | 316017813 | 05 | MO | MEDICAID | 410048079 | 01 | IL | RR MEDICARE | OTHER | 316017805 | 05 | MO | MEDICAID |