Provider Demographics
NPI:1013209261
Name:JOSEPH H MARTIN OD, P.A. & ASSOCIATES
Entity Type:Organization
Organization Name:JOSEPH H MARTIN OD, P.A. & ASSOCIATES
Other - Org Name:MARTIN EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-288-3412
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55903-0068
Mailing Address - Country:US
Mailing Address - Phone:952-288-3412
Mailing Address - Fax:952-460-3391
Practice Address - Street 1:810 COUNTY ROAD 42 W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4426
Practice Address - Country:US
Practice Address - Phone:952-288-3412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH H MARTIN OD, P.A. & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39820Medicare UPIN