Provider Demographics
NPI:1265671523
Name:MARTIN, DARA BETH (OD)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:BETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WATERTOWN ST UNIT 436
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2586
Mailing Address - Country:US
Mailing Address - Phone:201-674-1013
Mailing Address - Fax:
Practice Address - Street 1:83 NEWBURY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3284
Practice Address - Country:US
Practice Address - Phone:857-268-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00134000152W00000X
NJ27OA00579900152W00000X
NYTUV006347152W00000X
MA3958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist