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General NPI Number Information
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NPI Number | 1225057979
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Entity Type | Individual
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Provider Name | SAMUEL A. MARTIN JR. O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 201 A ST
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City | FARMVILLE
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State | VA
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Zip | 23901-1613
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Country | US
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Telephone | 434-392-8355
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Fax | 434-392-3042
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Provider Business Mailing Address
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Address Line | PO BOX 308
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City | FARMVILLE
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State | VA
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Zip | 23901-0308
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Country | US
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Telephone | 434-392-8355
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Fax | 434-392-3042
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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 | 0618000089
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License Number State | VA
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