Provider Demographics
NPI:1023205283
Name:MARTIN, DONNA (OD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:SIMONIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-0401
Mailing Address - Country:US
Mailing Address - Phone:603-543-1843
Mailing Address - Fax:
Practice Address - Street 1:14 BOWEN ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2329
Practice Address - Country:US
Practice Address - Phone:603-543-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13412TPA152W00000X
NH0820152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30356957Medicaid
NH30356957Medicaid
NH000807401Medicare PIN