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General NPI Number Information
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NPI Number | 1093166290
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Entity Type | Individual
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Provider Name | ELENA MARTINEZ O.D
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Gender | Female
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 117 SPARTA AVE
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City | SPARTA
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State | NJ
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Zip | 07871-1773
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Country | US
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Telephone | 973-726-0669
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Fax |
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Provider Business Mailing Address
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Address Line | 117 SPARTA AVE
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City | SPARTA
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State | NJ
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Zip | 07871-1773
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Country | US
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Telephone | 973-726-0669
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Fax |
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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 | 27OA00666600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OM00134600
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License Number State | NJ
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