Provider Demographics
NPI:1164567152
Name:MARTIN, LAURA LYN (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W NAPA ST
Mailing Address - Street 2:STE. 3
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6643
Mailing Address - Country:US
Mailing Address - Phone:707-938-3937
Mailing Address - Fax:707-939-8619
Practice Address - Street 1:201 W NAPA ST
Practice Address - Street 2:STE. 3
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6643
Practice Address - Country:US
Practice Address - Phone:707-938-3937
Practice Address - Fax:707-939-8619
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7521T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10549Medicare UPIN
CASD0075210Medicare ID - Type Unspecified