Provider Demographics
NPI:1548494156
Name:MARTIN EYE ASSOCIATES OD PA CORP
Entity type:Organization
Organization Name:MARTIN EYE ASSOCIATES OD PA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:919-362-1962
Mailing Address - Street 1:821 PERRY RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-7702
Mailing Address - Country:US
Mailing Address - Phone:919-362-1962
Mailing Address - Fax:919-589-9899
Practice Address - Street 1:821 PERRY RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-7702
Practice Address - Country:US
Practice Address - Phone:919-362-1962
Practice Address - Fax:919-589-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2471813DMedicare PIN