Provider Demographics
NPI:1932141355
Name:JOSEPH H. MARTIN OD, P.A.
Entity Type:Organization
Organization Name:JOSEPH H. MARTIN OD, P.A.
Other - Org Name:JOSEPH MARTIN & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-920-8770
Mailing Address - Street 1:2195 SOUTHDALE CTR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-7065
Mailing Address - Country:US
Mailing Address - Phone:952-920-8770
Mailing Address - Fax:
Practice Address - Street 1:2195 SOUTHDALE CTR
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-7065
Practice Address - Country:US
Practice Address - Phone:952-920-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2145152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC02668Medicare ID - Type UnspecifiedMEDICARE GROUP