MEDICARE: CHRISTINA ANN MARTINEZ OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT002376	AZ

General Provider Information

NPI Number	:	1548817786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA ANN MARTINEZ OD

Provider Business Mailing Address
First Line	:	2277 SWANSON AVE STE 100
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5991
Country	:	US
Telephone Number	:	928-855-5026
Fax Number	:

Provider Business Practice Location Address
First Line	:	2277 SWANSON AVE STE 100
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5991
Country	:	US
Telephone Number	:	928-855-5026
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	08/22/2019

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