Provider Demographics
NPI:1598875049
Name:MARTIN, ANGELA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6617 CROSSINGS DR SE STE 102
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7378
Mailing Address - Country:US
Mailing Address - Phone:616-485-9804
Mailing Address - Fax:616-541-7088
Practice Address - Street 1:6617 CROSSINGS DR SE STE 102
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7378
Practice Address - Country:US
Practice Address - Phone:616-541-7080
Practice Address - Fax:616-541-7088
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004369152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist