Provider Demographics
NPI:1336130012
Name:MARTON, KENNETH I (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:I
Last Name:MARTON
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 1:2117 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3231
Mailing Address - Country:US
Mailing Address - Phone:517-485-2213
Mailing Address - Fax:517-485-2220
Practice Address - Street 1:2117 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3231
Practice Address - Country:US
Practice Address - Phone:517-485-2213
Practice Address - Fax:517-485-2220
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKM002606152W00000X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5060594Medicaid
MI900C36552OtherBCBS OF MICHIGAN
MI5060594Medicaid
MI900C36552OtherBCBS OF MICHIGAN