Provider Demographics
NPI:1649482779
Name:MARTIN B. ZIEMAN OD, PA
Entity type:Organization
Organization Name:MARTIN B. ZIEMAN OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ZIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-235-2015
Mailing Address - Street 1:5225 NW 80TH TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1137
Mailing Address - Country:US
Mailing Address - Phone:239-565-1743
Mailing Address - Fax:941-743-9500
Practice Address - Street 1:1441 TAMIAMI TRL
Practice Address - Street 2:#0801
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1098
Practice Address - Country:US
Practice Address - Phone:941-235-2015
Practice Address - Fax:941-743-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT96171Medicare UPIN
FL19071CMedicare ID - Type Unspecified