Provider Demographics
NPI:1326063702
Name:AVILES, MARTIN A (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:A
Last Name:AVILES
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 1:28 MILLER CIR
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-1361
Mailing Address - Country:US
Mailing Address - Phone:212-861-6200
Mailing Address - Fax:212-288-6545
Practice Address - Street 1:229 E 79TH ST
Practice Address - Street 2:SUITE 1L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0866
Practice Address - Country:US
Practice Address - Phone:212-861-6200
Practice Address - Fax:212-288-6545
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005050-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5173906OtherDAVIS VISION
NY926275OtherBLOCK VISION
NY2023167OtherUNITED HEALTHCARE
NY3C9951OtherHEALTHNET
NYC42421Medicare ID - Type Unspecified
NY926275OtherBLOCK VISION