Provider Demographics
NPI:1639454556
Name:MARTINSVILLE FAMILY EYE CARE CENTER INC.
Entity Type:Organization
Organization Name:MARTINSVILLE FAMILY EYE CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-342-2050
Mailing Address - Street 1:1089 E MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1744
Mailing Address - Country:US
Mailing Address - Phone:765-342-2050
Mailing Address - Fax:765-342-5899
Practice Address - Street 1:1089 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1744
Practice Address - Country:US
Practice Address - Phone:765-342-2050
Practice Address - Fax:765-342-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100186570Medicaid
IN100186570Medicaid
T34942Medicare UPIN