Provider Demographics
NPI:1053448746
Name:MARTINI, AMANDA RAYE (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:RAYE
Last Name:MARTINI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W. WHEELER AVE.
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336
Mailing Address - Country:US
Mailing Address - Phone:361-758-3433
Mailing Address - Fax:361-758-3424
Practice Address - Street 1:2501 W. WHEELER AVE.
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336
Practice Address - Country:US
Practice Address - Phone:361-758-3433
Practice Address - Fax:361-758-3424
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6902T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist