Basic Information
| Provider Information | |||||||||
| NPI: | 1467429282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEATH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | LEVIN | ||||||||
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| Credential: | O. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD 520 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038478899 | ||||||||
| FaxNumber: | 7039910514 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 REVOLUTION ST | ||||||||
| Address2: | |||||||||
| City: | HARRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109392200 | ||||||||
| FaxNumber: | 4109395980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 08/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TA0793 | MD | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 410022555 | 01 | MEDICARE RAILROAD | OTHER |