Provider Demographics
NPI:1689647620
Name:MARTIN, WAYNE LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:LEE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:36 CUESTA WAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3404
Mailing Address - Country:US
Mailing Address - Phone:925-934-1192
Mailing Address - Fax:925-938-1716
Practice Address - Street 1:1811 YGNACIO VALLEY RD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3214
Practice Address - Country:US
Practice Address - Phone:925-933-1344
Practice Address - Fax:925-933-1419
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA4980T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist