Healthcare Provider Details

I. General information

NPI: 1285841973
Provider Name (Legal Business Name): ERIC MARTIN, O.D. AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 BERLIN RD UNIT B
HURON OH
44839-1706
US

IV. Provider business mailing address

421 BERLIN RD UNIT B
HURON OH
44839-1706
US

V. Phone/Fax

Practice location:
  • Phone: 419-433-3937
  • Fax: 419-433-0225
Mailing address:
  • Phone: 419-433-3937
  • Fax: 419-433-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4768T1572
License Number StateOH

VIII. Authorized Official

Name: DR. ERIC CHRISTOPHER MARTIN
Title or Position: OWNER
Credential: O.D.
Phone: 419-433-3937