Healthcare Provider Details

I. General information

NPI: 1760464838
Provider Name (Legal Business Name): EMILIO MARTINEZ-LEZAMA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 03/22/2023
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 PINE RIDGE RD
NAPLES FL
34109-2003
US

IV. Provider business mailing address

4652 SIESTA CIR
FORT MYERS FL
33901-8830
US

V. Phone/Fax

Practice location:
  • Phone: 239-330-3473
  • Fax:
Mailing address:
  • Phone: 901-289-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4214
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: