Provider Demographics
NPI:1457756280
Name:RONALD J MARTIN OD A PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:RONALD J MARTIN OD A PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:VISION HEALTH OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-206-0290
Mailing Address - Street 1:1440 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2987
Mailing Address - Country:US
Mailing Address - Phone:707-206-0290
Mailing Address - Fax:707-585-8018
Practice Address - Street 1:1440 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2987
Practice Address - Country:US
Practice Address - Phone:707-206-0290
Practice Address - Fax:707-585-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11182T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty