Provider Demographics
NPI:1922420561
Name:DR MARTIN DOLL OD INC
Entity Type:Organization
Organization Name:DR MARTIN DOLL OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-372-7525
Mailing Address - Street 1:7562 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3002
Mailing Address - Country:US
Mailing Address - Phone:714-372-7525
Mailing Address - Fax:
Practice Address - Street 1:7562 CENTER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3002
Practice Address - Country:US
Practice Address - Phone:714-372-7525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2023-05-24
Deactivation Date:2023-04-20
Deactivation Code:
Reactivation Date:2023-05-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty