Provider Demographics
NPI:1841204013
Name:MARTIN, DAVID F (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:MARTIN
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 1:444 N EOLA RD
Mailing Address - Street 2:#105
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9615
Mailing Address - Country:US
Mailing Address - Phone:630-862-2020
Mailing Address - Fax:630-862-2027
Practice Address - Street 1:444 N EOLA RD
Practice Address - Street 2:#105
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9615
Practice Address - Country:US
Practice Address - Phone:630-862-2020
Practice Address - Fax:630-862-2027
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009753OtherBCBS
ILV07220Medicare UPIN
ILK22578Medicare ID - Type Unspecified
ILIL4373001Medicare PIN