Provider Demographics
NPI:1982776910
Name:ZIEMAN, MARTIN B (OD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:B
Last Name:ZIEMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1441 TAMIAMI TRL
Mailing Address - Street 2:0801
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1098
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT96171Medicare UPIN
FL19071CMedicare PIN