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General NPI Number Information
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NPI Number | 1164868865
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Entity Type | Organization
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Legal Business Name | MARTIN EYECARE, PLLC
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 121 E MARION AVE
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City | PUNTA GORDA
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State | FL
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Zip | 33950-3635
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Country | US
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Telephone | 941-883-9044
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Fax |
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Provider Business Mailing Address
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Address Line | 357 COLDEWAY DR
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City | PUNTA GORDA
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State | FL
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Zip | 33950-5285
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Country | US
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Telephone | 405-708-3462
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER GAIL MARTIN MAPLES
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Credential | O.D.
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Telephone | 405-708-3462
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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 | OPC 4277
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License Number State | FL
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