Provider Demographics
NPI:1649040700
Name:DODD, MARTIN JOSEPH
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOSEPH
Last Name:DODD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3211
Mailing Address - Country:US
Mailing Address - Phone:707-445-2079
Mailing Address - Fax:707-445-2070
Practice Address - Street 1:2039 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3211
Practice Address - Country:US
Practice Address - Phone:707-445-2079
Practice Address - Fax:707-445-2070
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5746156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician