Provider Demographics
NPI:1730179904
Name:FABER, MARTIN L (OD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:FABER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N DAVIS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3200
Mailing Address - Country:US
Mailing Address - Phone:817-265-8525
Mailing Address - Fax:817-860-6056
Practice Address - Street 1:910 N DAVIS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3200
Practice Address - Country:US
Practice Address - Phone:817-265-8525
Practice Address - Fax:817-860-6056
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3169TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB129518Medicare PIN
TXU82500Medicare UPIN