Provider Demographics
NPI:1134233265
Name:MARTINO, IRENE (OD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:MARTINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11565 ASCOT LN
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021-9342
Mailing Address - Country:US
Mailing Address - Phone:440-708-1791
Mailing Address - Fax:440-708-0357
Practice Address - Street 1:7235 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8758
Practice Address - Country:US
Practice Address - Phone:330-562-6350
Practice Address - Fax:330-562-9528
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist