Provider Demographics
NPI:1902930258
Name:KASS, MARTIN DAVID (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:DAVID
Last Name:KASS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 TENNEY MOUNTAIN HWY
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:607 TENNEY MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3156
Practice Address - Country:US
Practice Address - Phone:603-536-3569
Practice Address - Fax:603-536-3654
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH014156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30003865Medicaid
NH0780050001Medicare ID - Type Unspecified