Provider Demographics
NPI:1730390261
Name:MARTIN, JOSEPH PERRY (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PERRY
Last Name:MARTIN
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 1:9862 GRANITE SLOPE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-6004
Mailing Address - Country:US
Mailing Address - Phone:801-943-0970
Mailing Address - Fax:
Practice Address - Street 1:166 E 5900 S
Practice Address - Street 2:SUIT B103
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7257
Practice Address - Country:US
Practice Address - Phone:801-268-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111309-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU06413Medicare UPIN
UTU000075010Medicare PIN