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General NPI Number Information
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NPI Number | 1003921487
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Entity Type | Individual
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Provider Name | RICHARD LEE MARTIN JR. O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 2399 STATE ROAD 46 SOUTH WAL-MART VISION CENTER
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City | TERRE HAUTE
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State | IN
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Zip | 47803
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Country | US
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Telephone | 812-872-2537
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Fax | 812-872-2539
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Provider Business Mailing Address
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Address Line | 901 EVENSVIEW DR
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City | GREENCASTLE
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State | IN
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Zip | 46135-1105
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Country | US
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Telephone | 765-653-8245
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Fax | 765-653-5009
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003118A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 18003118A
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License Number State | IN
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