Healthcare Provider Details

I. General information

NPI: 1013775816
Provider Name (Legal Business Name): MARINDA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALMART VISION CENTER 5450 NEW HOPE COMMONS DR
DURHAM NC
27707
US

IV. Provider business mailing address

PO BOX 176
EFLAND NC
27243-0176
US

V. Phone/Fax

Practice location:
  • Phone: 919-489-4156
  • Fax: 919-403-6037
Mailing address:
  • Phone: 919-357-4437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1983
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: