Provider Demographics
NPI:1356497267
Name:DANIEL T. MARTINEZ O.D., INC.
Entity type:Organization
Organization Name:DANIEL T. MARTINEZ O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRY
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-960-8655
Mailing Address - Street 1:14319 RAMONA BLVD
Mailing Address - Street 2:14319 RAMONA BLVD.
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3242
Mailing Address - Country:US
Mailing Address - Phone:626-960-8655
Mailing Address - Fax:626-960-7802
Practice Address - Street 1:14319 RAMONA BLVD
Practice Address - Street 2:14319 RAMONA BLVD.
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3242
Practice Address - Country:US
Practice Address - Phone:626-960-8655
Practice Address - Fax:626-960-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0082760Medicaid
CAW20333Medicare PIN
CASD0082760Medicaid