Provider Demographics
NPI:1356505879
Name:MARTIN, ANDREA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
Last Name:MARTIN
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 1:5166 NIAGARA LN
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7168
Mailing Address - Country:US
Mailing Address - Phone:330-931-1686
Mailing Address - Fax:
Practice Address - Street 1:3100 MAIN ST
Practice Address - Street 2:#723
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9867
Practice Address - Country:US
Practice Address - Phone:419-878-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist