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General NPI Number Information
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NPI Number | 1336211283
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Entity Type | Organization
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Legal Business Name | STILLWATER EYECARE CENTER, P.L.L.C.
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 707 S WESTERN RD
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City | STILLWATER
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State | OK
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Zip | 74074-4126
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Country | US
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Telephone | 405-743-1134
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Fax |
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Provider Business Mailing Address
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Address Line | 707 S WESTERN RD
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City | STILLWATER
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State | OK
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Zip | 74074-4126
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Country | US
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Telephone | 405-743-1134
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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. STEPHEN R. MARTIN
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Credential | M.D.
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Telephone | 405-743-4212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 13792
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License Number State | OK
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