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General NPI Number Information
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NPI Number | 1376299040
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Entity Type | Individual
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Provider Name | ELIZA MARGUERITE WHATLEY MARTIN O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/22/2022
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Last Update Date | 12/27/2025
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Provider Practice Location Address
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Address Line | 180 S MAIN ST STE B2
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City | DRIGGS
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State | ID
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Zip | 83422-5034
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Country | US
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Telephone | 208-471-8721
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Fax | 208-471-8727
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Provider Business Mailing Address
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Address Line | 7973 SPOON CREEK DR
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City | VICTOR
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State | ID
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Zip | 83455-4992
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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 |
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Name |
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Credential |
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Telephone |
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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 | ODP-100599
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG004119
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618003187
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4280
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License Number State | MT
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 447T
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License Number State | WY
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Taxonomy #6
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TPOP280
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12793207-9934
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License Number State | UT
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Taxonomy #8
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD61409137
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License Number State | WA
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