Provider Demographics
NPI:1437318391
Name:BURKE D. MARTIN, OD
Entity Type:Organization
Organization Name:BURKE D. MARTIN, OD
Other - Org Name:ROUND ROCK EYE DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-785-0624
Mailing Address - Street 1:1308 ARRONIMINK CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6303
Mailing Address - Country:US
Mailing Address - Phone:512-785-0624
Mailing Address - Fax:
Practice Address - Street 1:2701 S I H 35
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7320
Practice Address - Country:US
Practice Address - Phone:512-388-2600
Practice Address - Fax:512-388-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5141T152W00000X, 152WC0802X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX64765OtherSAFEGUARD
TX49292 & 47839OtherDAVIS VISION
TX019327801Medicaid
TX020635 & 024923OtherBLOCK VISION (CHIP AND AMERIGROUP)
TX13860 & 35403OtherAVESIS
TX2600OtherMEDICAL EYE SERVICE
TX19973 & 26903OtherSPECTERA
TX550475 &545480OtherNATIONAL VISION ADMINISTRATORS