Provider Demographics
NPI:1639692809
Name:MARTIN EYE CARE LLC
Entity Type:Organization
Organization Name:MARTIN EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:708-203-6040
Mailing Address - Street 1:6541 27TH PL
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2769
Mailing Address - Country:US
Mailing Address - Phone:708-203-6040
Mailing Address - Fax:
Practice Address - Street 1:5153 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4219
Practice Address - Country:US
Practice Address - Phone:773-284-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center