Provider Demographics
NPI:1598821902
Name:MARTINELLI, RANDY M (LDO)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:M
Last Name:MARTINELLI
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5062 WEST ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8129
Mailing Address - Country:US
Mailing Address - Phone:561-498-8884
Mailing Address - Fax:561-498-7878
Practice Address - Street 1:2514 PGA BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2902
Practice Address - Country:US
Practice Address - Phone:561-500-8884
Practice Address - Fax:561-500-8885
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLFL3876156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6116270001Medicare NSC