Provider Demographics
NPI:1841903721
Name:MARTINEZ, MATTHEW JAMES (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:MARTINEZ
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 1:10200 W 136TH PL APT 2503
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-7830
Mailing Address - Country:US
Mailing Address - Phone:620-255-2353
Mailing Address - Fax:
Practice Address - Street 1:8500 W 110TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1874
Practice Address - Country:US
Practice Address - Phone:877-674-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2023003346152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program