Provider Demographics
NPI:1265692131
Name:S.A.MARTIN, JR. OD PC
Entity type:Organization
Organization Name:S.A.MARTIN, JR. OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD PC
Authorized Official - Phone:434-392-8355
Mailing Address - Street 1:201 A ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1613
Mailing Address - Country:US
Mailing Address - Phone:434-392-8355
Mailing Address - Fax:434-392-3042
Practice Address - Street 1:201 A ST
Practice Address - Street 2:SUITE B
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1613
Practice Address - Country:US
Practice Address - Phone:434-392-8355
Practice Address - Fax:434-392-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009203095Medicaid
VA8043928355OtherVSP
VA540001094OtherMEDICARE RAIL ROAD
VA075554OtherBLUE CROSS BLUE SHIELD
VA6271OtherDAVIS VISION
VAVA0089OtherBLUE VIEW/EYE MED
VA0225110001Medicare NSC
VA075554OtherBLUE CROSS BLUE SHIELD
VA540001094OtherMEDICARE RAIL ROAD