Provider Demographics
NPI:1558646810
Name:L MARTIN EYE INCORPORATED
Entity Type:Organization
Organization Name:L MARTIN EYE INCORPORATED
Other - Org Name:LAURA MARTIN, OD
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-270-8205
Mailing Address - Street 1:9 SEDGEWICK ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2899
Mailing Address - Country:US
Mailing Address - Phone:617-270-8205
Mailing Address - Fax:
Practice Address - Street 1:7 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2701
Practice Address - Country:US
Practice Address - Phone:617-361-0618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0024663Medicare PIN