Provider Demographics
NPI:1255304754
Name:MARTIN, CAROLYN J (OD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:100 VERDE VALLEY SCHOOL ROAD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351
Mailing Address - Country:US
Mailing Address - Phone:928-239-9901
Mailing Address - Fax:928-239-9902
Practice Address - Street 1:100 VERDE VALLEY SCHOOL ROAD
Practice Address - Street 2:SUITE 114
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351
Practice Address - Country:US
Practice Address - Phone:928-239-9901
Practice Address - Fax:928-239-9902
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2015-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1467152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ107682Medicare PIN
AZU65901Medicare UPIN