Provider Demographics
NPI:1710947098
Name:MARTIN VISION PC
Entity Type:Organization
Organization Name:MARTIN VISION PC
Other - Org Name:MARTIN VISION PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-660-2162
Mailing Address - Street 1:13505 HERRING RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-2946
Mailing Address - Country:US
Mailing Address - Phone:719-282-8555
Mailing Address - Fax:718-282-8555
Practice Address - Street 1:388 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1713
Practice Address - Country:US
Practice Address - Phone:719-391-2000
Practice Address - Fax:844-273-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99382041Medicaid
CO06002242Medicaid