Provider Demographics
NPI:1003816018
Name:ORLICK, MARTIN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:EDWARD
Last Name:ORLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 49TH ST N
Mailing Address - Street 2:S-109
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2146
Mailing Address - Country:US
Mailing Address - Phone:727-522-1115
Mailing Address - Fax:727-522-0018
Practice Address - Street 1:5800 49TH ST N
Practice Address - Street 2:S-109
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2146
Practice Address - Country:US
Practice Address - Phone:727-522-1115
Practice Address - Fax:727-522-0018
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051975207W00000X
FLME00151975207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054970300Medicaid
FL11745ZMedicare PIN
A99725Medicare UPIN
FL054970300Medicaid
FL11745VMedicare PIN
FL11745XMedicare PIN