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General NPI Number Information
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NPI Number | 1366627127
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Entity Type | Organization
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Legal Business Name | DR NICK MARTIN EYE CARE CENTER
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Dates
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Enumeration Date | 12/29/2007
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Last Update Date | 10/20/2017
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Provider Practice Location Address
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Address Line | 7025 S MEMORIAL DR #248
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City | TULSA
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State | OK
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Zip | 74133-2037
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Country | US
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Telephone | 918-250-6766
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Fax | 918-250-8246
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Provider Business Mailing Address
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Address Line | 7025 S MEMORIAL DR #248
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City | TULSA
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State | OK
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Zip | 74133-2037
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Country | US
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Telephone | 918-250-6766
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Fax | 918-250-8246
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. NICK G MARTIN
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Credential | OD
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Telephone | 918-250-6766
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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 | 1151
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License Number State | OK
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