Provider Demographics
NPI:1457468597
Name:MARTIN, DOUGLAS N (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:N
Last Name:MARTIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 HIGHWAY 287 N
Mailing Address - Street 2:STE 109
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2611
Mailing Address - Country:US
Mailing Address - Phone:817-570-2050
Mailing Address - Fax:
Practice Address - Street 1:5616 SW GREEN OAKS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1159
Practice Address - Country:US
Practice Address - Phone:817-570-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3815152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXO37785501Medicaid
TXT91278Medicare UPIN
TXO37785501Medicaid