Healthcare Provider Details

I. General information

NPI: 1043204720
Provider Name (Legal Business Name): DR. LOUIS MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5210 BOX 230
APO AE
09464-8730
GB

IV. Provider business mailing address

PSC 41 BOX 829
APO AE
09464-0801
GB

V. Phone/Fax

Practice location:
  • Phone: 163-852-9213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: