Provider Demographics
NPI:1376844993
Name:BUCKLEY, MARTHA PATRICIA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:PATRICIA
Last Name:BUCKLEY
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 1:19648 CRYSTAL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3875
Mailing Address - Country:US
Mailing Address - Phone:310-990-2356
Mailing Address - Fax:
Practice Address - Street 1:19648 CRYSTAL RIDGE LN
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-3875
Practice Address - Country:US
Practice Address - Phone:310-990-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11560T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist