Healthcare Provider Details

I. General information

NPI: 1184440232
Provider Name (Legal Business Name): ELEANOR CHERIE MARTIN LDO/ABO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 CHESAPEAKE SQUARE RING RD
CHESAPEAKE VA
23321-2173
US

IV. Provider business mailing address

2401 BALLAHACK RD
CHESAPEAKE VA
23322-2860
US

V. Phone/Fax

Practice location:
  • Phone: 757-488-6916
  • Fax: 757-465-2030
Mailing address:
  • Phone: 757-342-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: