Provider Demographics
NPI:1841419710
Name:MARTIN, BRUCE E (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GIBRALTAR DR
Mailing Address - Street 2:POWDER MILL PLAZA, RT 10 EAST
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1273
Mailing Address - Country:US
Mailing Address - Phone:973-267-2111
Mailing Address - Fax:
Practice Address - Street 1:30 GIBRALTAR DR
Practice Address - Street 2:POWDER MILL PLAZA, RT 10 EAST
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1273
Practice Address - Country:US
Practice Address - Phone:973-267-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ874156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician