Provider Demographics
NPI:1275264863
Name:BALL, MARTHA ISABEL
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ISABEL
Last Name:BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BENTON RD
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-2168
Mailing Address - Country:US
Mailing Address - Phone:864-834-9868
Mailing Address - Fax:
Practice Address - Street 1:9 BENTON RD
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-2168
Practice Address - Country:US
Practice Address - Phone:864-834-9868
Practice Address - Fax:864-834-0567
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC922156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician