Healthcare Provider Details

I. General information

NPI: 1043486905
Provider Name (Legal Business Name): MARTINS FINE EYEWEAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 N 115TH ST #110
SEATTLE WA
98133-8400
US

IV. Provider business mailing address

1536 N 115TH ST #110
SEATTLE WA
98133-8400
US

V. Phone/Fax

Practice location:
  • Phone: 206-363-6003
  • Fax: 206-363-6004
Mailing address:
  • Phone: 206-363-6003
  • Fax: 206-363-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DONN A SOGN
Title or Position: PRESIDENT
Credential: LDO
Phone: 206-363-6003