Provider Demographics
NPI:1184688004
Name:MARTINEZ, DANIEL THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:THOMAS
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14319 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3242
Mailing Address - Country:US
Mailing Address - Phone:626-960-8655
Mailing Address - Fax:626-960-7802
Practice Address - Street 1:14319 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3242
Practice Address - Country:US
Practice Address - Phone:626-960-8655
Practice Address - Fax:626-960-7802
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8276T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0082760Medicaid
CASD0082760Medicaid
CAW20333Medicare PIN