Provider Demographics
NPI:1306866405
Name:DO, MARTIN T (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:T
Last Name:DO
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:6301 NW LOOP 410
Mailing Address - Street 2:STE R6-A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3824
Mailing Address - Country:US
Mailing Address - Phone:210-767-0202
Mailing Address - Fax:210-767-0216
Practice Address - Street 1:6301 NW LOOP 410
Practice Address - Street 2:STE R6-A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3824
Practice Address - Country:US
Practice Address - Phone:210-767-0202
Practice Address - Fax:210-767-0216
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX6344T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU95817Medicare UPIN