Provider Demographics
NPI:1043541857
Name:KEVIN P & LAURA L MARTIN
Entity Type:Organization
Organization Name:KEVIN P & LAURA L MARTIN
Other - Org Name:SONOMA OPTOMETRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-225-5738
Mailing Address - Street 1:201 W NAPA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6621
Mailing Address - Country:US
Mailing Address - Phone:707-938-3937
Mailing Address - Fax:707-939-8619
Practice Address - Street 1:201 W NAPA ST STE 3
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6621
Practice Address - Country:US
Practice Address - Phone:707-938-3937
Practice Address - Fax:707-939-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEB498AMedicare PIN