Healthcare Provider Details

I. General information

NPI: 1477128163
Provider Name (Legal Business Name): JEM MARTIN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEM MARTIN OD

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 COMMONWEALTH AVE
BOSTON MA
02215-1274
US

IV. Provider business mailing address

424 BEACON ST
BOSTON MA
02115-1129
US

V. Phone/Fax

Practice location:
  • Phone: 617-262-2020
  • Fax:
Mailing address:
  • Phone: 617-587-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number5493
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: