Provider Demographics
NPI:1447238183
Name:MARTIN, JEFFREY K (OS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:M
Credentials:OS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 W WATER ST
Mailing Address - Street 2:P.O. BOX 1639
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2426
Mailing Address - Country:US
Mailing Address - Phone:740-773-5718
Mailing Address - Fax:740-773-5719
Practice Address - Street 1:176 W WATER ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2426
Practice Address - Country:US
Practice Address - Phone:740-773-5718
Practice Address - Fax:740-773-5719
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3323152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0499321Medicare PIN
OHT47322Medicare UPIN