Provider Demographics
NPI:1033115886
Name:MARTIN, DAWN MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MICHELLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3940 E UNIVERSITY DR
Mailing Address - Street 2:STE 5
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6945
Mailing Address - Country:US
Mailing Address - Phone:480-832-0030
Mailing Address - Fax:480-924-7268
Practice Address - Street 1:3940 E UNIVERSITY DR
Practice Address - Street 2:STE 5
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-6945
Practice Address - Country:US
Practice Address - Phone:480-832-0030
Practice Address - Fax:480-924-7268
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ815152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU28314Medicare UPIN
AZ26932Medicare ID - Type Unspecified