Provider Demographics
NPI:1982647459
Name:REILLY, MARTHA (O D)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 259915
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53725-9915
Mailing Address - Country:US
Mailing Address - Phone:608-848-7225
Mailing Address - Fax:
Practice Address - Street 1:135 E TOWNE MALL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3713
Practice Address - Country:US
Practice Address - Phone:608-848-7225
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist