Provider Demographics
NPI:1154849495
Name:MARTEL EYE INSTITUTE LLC
Entity Type:Organization
Organization Name:MARTEL EYE INSTITUTE LLC
Other - Org Name:MARTEL EYE INSTITUTE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-631-7868
Mailing Address - Street 1:11216 TRINITY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2968
Mailing Address - Country:US
Mailing Address - Phone:916-631-7868
Mailing Address - Fax:916-631-3788
Practice Address - Street 1:11216 TRINITY RIVER DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2968
Practice Address - Country:US
Practice Address - Phone:916-631-7868
Practice Address - Fax:916-631-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA106056261QA1903X
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629376207Medicaid
CA1629376207OtherALL INSURANCE