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General NPI Number Information
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NPI Number | 1366688509
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Entity Type | Organization
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Legal Business Name | JEFFREY K MARTIN OD
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 176 W WATER ST
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-2426
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Country | US
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Telephone | 740-773-5718
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Fax | 740-773-5719
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Provider Business Mailing Address
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Address Line | 176 W WATER ST
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-2426
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY K MARTIN
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Credential | O.D.
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Telephone | 740-773-5718
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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 | 3323
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License Number State | OH
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