Provider Demographics
NPI:1366627127
Name:DR NICK MARTIN EYE CARE CENTER
Entity Type:Organization
Organization Name:DR NICK MARTIN EYE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-250-6766
Mailing Address - Street 1:7025 S MEMORIAL DR
Mailing Address - Street 2:#248
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2037
Mailing Address - Country:US
Mailing Address - Phone:918-250-6766
Mailing Address - Fax:918-250-8246
Practice Address - Street 1:7025 S MEMORIAL DR
Practice Address - Street 2:#248
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2037
Practice Address - Country:US
Practice Address - Phone:918-250-6766
Practice Address - Fax:918-250-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-29
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522217Medicare PIN