Provider Demographics
NPI:1851522445
Name:MARTINEZ, TIFFANY GARCIA (OD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GARCIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANNE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:502 EL PUEBLO RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1105
Mailing Address - Country:US
Mailing Address - Phone:505-385-0826
Mailing Address - Fax:
Practice Address - Street 1:502 EL PUEBLO RD NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87114-1105
Practice Address - Country:US
Practice Address - Phone:505-385-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist