Provider Demographics
NPI:1003921487
Name:MARTIN, RICHARD LEE JR (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:MARTIN
Suffix:JR
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 1:901 EVENSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-1105
Mailing Address - Country:US
Mailing Address - Phone:765-653-8245
Mailing Address - Fax:765-653-5009
Practice Address - Street 1:2399 STATE ROAD 46 SOUTH
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803
Practice Address - Country:US
Practice Address - Phone:812-872-2537
Practice Address - Fax:812-872-2539
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003118A152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management