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General NPI Number Information
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NPI Number | 1265692131
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Entity Type | Organization
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Legal Business Name | S.A.MARTIN, JR. OD PC
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 201 A ST SUITE B
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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 | 201 A ST SUITE B
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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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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | SAMUEL A. MARTIN JR.
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Credential | OD PC
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Telephone | 434-392-8355
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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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