Provider Demographics
NPI:1346864964
Name:DEMARTINO, MEGAN NICOLE (OD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
Last Name:DEMARTINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2681 BROOK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6801
Mailing Address - Country:US
Mailing Address - Phone:814-444-2897
Mailing Address - Fax:
Practice Address - Street 1:1050 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3540
Practice Address - Country:US
Practice Address - Phone:954-458-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5813152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist