Provider Demographics
NPI:1629071865
Name:BAUMOHL, MARTIN JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOSEPH
Last Name:BAUMOHL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 FM 2920 RD
Mailing Address - Street 2:STE. I
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3589
Mailing Address - Country:US
Mailing Address - Phone:281-353-8300
Mailing Address - Fax:281-353-7694
Practice Address - Street 1:2616 FM 2920 RD
Practice Address - Street 2:STE. I
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3589
Practice Address - Country:US
Practice Address - Phone:281-353-8300
Practice Address - Fax:281-353-7694
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4949TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103015703Medicaid
TX8B1085Medicare PIN
TX8A7636Medicare ID - Type Unspecified
TXU52651Medicare UPIN