Provider Demographics
NPI:1275710303
Name:MICHELLE L. MARTINEZ OD. PA
Entity Type:Organization
Organization Name:MICHELLE L. MARTINEZ OD. PA
Other - Org Name:NORTHEAST EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-284-5786
Mailing Address - Street 1:900 W PIPELINE RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4818
Mailing Address - Country:US
Mailing Address - Phone:817-284-5786
Mailing Address - Fax:817-284-9529
Practice Address - Street 1:900 W PIPELINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4818
Practice Address - Country:US
Practice Address - Phone:817-284-5786
Practice Address - Fax:817-284-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6231TG261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00894WMedicare PIN