Provider Demographics
NPI:1790940377
Name:RAYMOND C. MARTINEZ, O.D. P.L.L.C.
Entity Type:Organization
Organization Name:RAYMOND C. MARTINEZ, O.D. P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-599-3937
Mailing Address - Street 1:8127 AGORA PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78154-4131
Mailing Address - Country:US
Mailing Address - Phone:210-599-3937
Mailing Address - Fax:
Practice Address - Street 1:8127 AGORA PARKWAY
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78154-4131
Practice Address - Country:US
Practice Address - Phone:210-599-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3968 TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT79041Medicare UPIN