Provider Demographics
NPI:1164868865
Name:MARTIN EYECARE, PLLC
Entity Type:Organization
Organization Name:MARTIN EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GAIL MARTIN
Authorized Official - Last Name:MAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-708-3462
Mailing Address - Street 1:357 COLDEWAY DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5285
Mailing Address - Country:US
Mailing Address - Phone:405-708-3462
Mailing Address - Fax:
Practice Address - Street 1:121 E MARION AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3635
Practice Address - Country:US
Practice Address - Phone:941-883-9044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4277152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty