Provider Demographics
NPI:1407948599
Name:MARTINEZ, CARLOS JAVIER (OD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:JAVIER
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1842
Mailing Address - Country:US
Mailing Address - Phone:908-227-1485
Mailing Address - Fax:
Practice Address - Street 1:16 MAIDEN LN
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-2024
Practice Address - Country:US
Practice Address - Phone:732-748-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00490200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3407608Medicaid
NJT89651Medicare UPIN
NJ3407608Medicaid