MEDICARE: DR. RENEE V MARTIN 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	4901003280	MI

General Provider Information

NPI Number	:	1902894561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE V MARTIN OD

Provider Business Mailing Address
First Line	:	110 S GREENVILLE WEST DR
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-3560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 S GREENVILLE WEST DR
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-3560
Country	:	US
Telephone Number	:	616-754-0000
Fax Number	:	616-754-2778

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	04/25/2016

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Directions to “ DR. RENEE V MARTIN OD” Practice Location

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