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General NPI Number Information
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NPI Number | 1396095097
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Entity Type | Individual
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Provider Name | JAMIE MARIE ST. MARTIN OD, FAAO
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Gender | Female
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 4917 SW 56TH ST
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City | OCALA
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State | FL
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Zip | 34474-4754
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Country | US
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Telephone | 352-804-9095
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Fax | 352-877-3253
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Provider Business Mailing Address
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Address Line | 4917 SW 56TH ST
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City | OCALA
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State | FL
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Zip | 34474-4754
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Country | US
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Telephone | 352-804-9095
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Fax | 352-877-3253
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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 | 3264-35
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License Number State | WI
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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 | OPC4763
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License Number State | FL
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