Provider Demographics
NPI:1952496960
Name:SANTA CROCE, MARTHA LAUREL (OD)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LAUREL
Last Name:SANTA CROCE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 DICKINSON AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1737
Mailing Address - Country:US
Mailing Address - Phone:607-724-0102
Mailing Address - Fax:607-786-5318
Practice Address - Street 1:32 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5450
Practice Address - Country:US
Practice Address - Phone:607-754-8670
Practice Address - Fax:607-786-5318
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTU-005380-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC8936Medicare PIN