Provider Demographics
NPI:1770601858
Name:STORBECK, MARTIN E (OD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:E
Last Name:STORBECK
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 1:329 US HIGHWAY 202-206
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2442
Mailing Address - Country:US
Mailing Address - Phone:908-685-0794
Mailing Address - Fax:
Practice Address - Street 1:329 US HIGHWAY 202-206
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2442
Practice Address - Country:US
Practice Address - Phone:908-685-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00476600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T77780Medicare UPIN