Provider Demographics
NPI:1598774747
Name:NEAL, MARTIN K (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:K
Last Name:NEAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7670 PAINTED TURTLE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-1757
Mailing Address - Country:US
Mailing Address - Phone:937-890-2944
Mailing Address - Fax:
Practice Address - Street 1:7725 HOKE RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OH
Practice Address - Zip Code:45315-9725
Practice Address - Country:US
Practice Address - Phone:937-836-9303
Practice Address - Fax:937-836-9308
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3561/T820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT47966Medicare UPIN