Healthcare Provider Details

I. General information

NPI: 1457586976
Provider Name (Legal Business Name): MARTINEZ EYE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 06/11/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 WRIGHTSBORO RD SUITE 905
AUGUSTA GA
30909-2500
US

IV. Provider business mailing address

PO BOX 3151
EVANS GA
30809-0079
US

V. Phone/Fax

Practice location:
  • Phone: 706-736-3937
  • Fax: 706-736-3938
Mailing address:
  • Phone: 812-219-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2274
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ABDUL DARANIJOH
Title or Position: CEO
Credential: OD
Phone: 812-219-3207