Provider Demographics
NPI:1932261211
Name:MARTINEZ, RAYMOND CARLOS (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:CARLOS
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 1:8127 AGORA PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78154-4131
Mailing Address - Country:US
Mailing Address - Phone:210-599-3937
Mailing Address - Fax:210-566-3339
Practice Address - Street 1:8127 AGORA PARKWAY
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78154-4131
Practice Address - Country:US
Practice Address - Phone:210-599-3937
Practice Address - Fax:210-566-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3968 TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611093Medicare ID - Type UnspecifiedPROVIDER NUMBER
TXT79041Medicare UPIN