Provider Demographics
NPI:1437283322
Name:MARTIN RAWDIN, O.D.
Entity Type:Organization
Organization Name:MARTIN RAWDIN, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWDIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-323-8007
Mailing Address - Street 1:1630 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-0341
Mailing Address - Country:US
Mailing Address - Phone:610-323-8007
Mailing Address - Fax:
Practice Address - Street 1:1630 HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-0341
Practice Address - Country:US
Practice Address - Phone:610-323-8007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000895152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU01007Medicare UPIN
PA283489Medicare ID - Type Unspecified
PA0139250001Medicare NSC