Provider Demographics
NPI:1225312879
Name:SAMARTINO, BRIAN C (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:SAMARTINO
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 1:571 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1445
Mailing Address - Country:US
Mailing Address - Phone:856-858-3937
Mailing Address - Fax:856-425-2571
Practice Address - Street 1:571 HADDON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-1445
Practice Address - Country:US
Practice Address - Phone:856-858-3937
Practice Address - Fax:856-425-2571
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00631700152W00000X
NJ27OA00631702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0291510Medicaid
NJ235727ZKMTOtherMEDICARE PTAN