Provider Demographics
NPI:1548099005
Name:MARTINEZ, THERESA YVONNE (ABOC, NCLEC)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:YVONNE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:ABOC, NCLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3238 GARBETT TER
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34288-8794
Mailing Address - Country:US
Mailing Address - Phone:941-920-8639
Mailing Address - Fax:
Practice Address - Street 1:19100 MURDOCK CIR
Practice Address - Street 2:VISION CENTER
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1022
Practice Address - Country:US
Practice Address - Phone:941-625-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5304156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician