Provider Demographics
NPI:1811191091
Name:LORA N MARTINEZ
Entity Type:Organization
Organization Name:LORA N MARTINEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORA
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-514-0559
Mailing Address - Street 1:325 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-3105
Mailing Address - Country:US
Mailing Address - Phone:956-514-0559
Mailing Address - Fax:
Practice Address - Street 1:325 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-3105
Practice Address - Country:US
Practice Address - Phone:956-514-0559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5142TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1811190091Medicaid
TX1811190091Medicaid
TX00194RMedicare PIN