Provider Demographics
NPI:1013200575
Name:MARTIN, HEIDI ELISE (DO)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ELISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MAY ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1719
Mailing Address - Country:US
Mailing Address - Phone:781-856-5744
Mailing Address - Fax:
Practice Address - Street 1:224 N BROADWAY
Practice Address - Street 2:SUITE B1
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2145
Practice Address - Country:US
Practice Address - Phone:603-898-8252
Practice Address - Fax:603-898-3037
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOP00320156FX1800X
MA5887156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician