Provider Demographics
NPI:1184440232
Name:MARTIN, ELEANOR CHERIE (LDO/ABO)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:CHERIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LDO/ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BALLAHACK RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2860
Mailing Address - Country:US
Mailing Address - Phone:757-342-8580
Mailing Address - Fax:
Practice Address - Street 1:2448 CHESAPEAKE SQUARE RING RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2173
Practice Address - Country:US
Practice Address - Phone:757-488-6916
Practice Address - Fax:757-465-2030
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician