Healthcare Provider Details

I. General information

NPI: 1982535597
Provider Name (Legal Business Name): DAVID MARTIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 LEGACY PL
DEDHAM MA
02026-6837
US

IV. Provider business mailing address

95 DOUGLAS RD
LOWELL MA
01852-3109
US

V. Phone/Fax

Practice location:
  • Phone: 781-407-9600
  • Fax:
Mailing address:
  • Phone: 978-995-7503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number152W00000X
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: