Provider Demographics
NPI:1033802806
Name:MARTIN, ELENA VANSANT (OD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:VANSANT
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 SALUDA POINTE DR UNIT 415
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7060
Mailing Address - Country:US
Mailing Address - Phone:803-920-3798
Mailing Address - Fax:
Practice Address - Street 1:3618 SUNSET BLVD STE A
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3046
Practice Address - Country:US
Practice Address - Phone:803-732-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist