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General NPI Number Information
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NPI Number | 1225207889
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Entity Type | Organization
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Legal Business Name | MARTIN FAMILY EYECARE
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 925 MALLY ST
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City | TUSCALOOSA
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State | AL
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Zip | 35405-8785
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Country | US
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Telephone | 205-344-5111
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Fax | 205-344-5004
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Provider Business Mailing Address
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Address Line | 925 MALLY ST
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City | TUSCALOOSA
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State | AL
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Zip | 35405-8785
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Country | US
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Telephone | 205-344-5111
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Fax | 205-344-5004
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MARSTON C MARTIN
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Credential | OD
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Telephone | 205-344-5111
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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 | S846TA372
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License Number State | AL
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