Healthcare Provider Details

I. General information

NPI: 1033115886
Provider Name (Legal Business Name): DAWN MICHELLE MARTIN O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6343 E MAIN ST STE 7
MESA AZ
85205-8955
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 480-832-0030
  • Fax: 480-924-7268
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-000815
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: