Provider Demographics
NPI:1528393915
Name:MARTINEZ EYE CARE,P.C.
Entity Type:Organization
Organization Name:MARTINEZ EYE CARE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOPA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-868-8870
Mailing Address - Street 1:454 FURYS FERRY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9506
Mailing Address - Country:US
Mailing Address - Phone:706-868-8870
Mailing Address - Fax:706-868-8785
Practice Address - Street 1:454 FURYS FERRY RD
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-9506
Practice Address - Country:US
Practice Address - Phone:706-868-8870
Practice Address - Fax:706-868-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00849714AMedicaid
GA00849714AMedicaid