Provider Demographics
NPI:1366040305
Name:DR MARTINEZ OD, PLLC
Entity Type:Organization
Organization Name:DR MARTINEZ OD, PLLC
Other - Org Name:ST. ROSE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-848-3387
Mailing Address - Street 1:3515 SAINT ROSE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4596
Mailing Address - Country:US
Mailing Address - Phone:702-848-3387
Mailing Address - Fax:702-848-3778
Practice Address - Street 1:3515 SAINT ROSE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4596
Practice Address - Country:US
Practice Address - Phone:702-848-3387
Practice Address - Fax:702-848-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty