Provider Demographics
NPI:1760464838
Name:MARTINEZ-LEZAMA, EMILIO (OD)
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:
Last Name:MARTINEZ-LEZAMA
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 1:4652 SIESTA CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8830
Mailing Address - Country:US
Mailing Address - Phone:901-289-1877
Mailing Address - Fax:
Practice Address - Street 1:2324 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2003
Practice Address - Country:US
Practice Address - Phone:239-330-3473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4214152W00000X
FL1451152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000996800Medicaid
FL000996800Medicaid
FLAK358YMedicare PIN