Provider Demographics
NPI:1285841973
Name:ERIC MARTIN, O.D. AND ASSOCIATES
Entity Type:Organization
Organization Name:ERIC MARTIN, O.D. AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-433-3937
Mailing Address - Street 1:421 BERLIN RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1706
Mailing Address - Country:US
Mailing Address - Phone:419-433-3937
Mailing Address - Fax:419-433-0225
Practice Address - Street 1:421 BERLIN RD UNIT B
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1706
Practice Address - Country:US
Practice Address - Phone:419-433-3937
Practice Address - Fax:419-433-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4768T1572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0430895Medicaid
OHMA4016281Medicare ID - Type Unspecified
OHU67516Medicare UPIN