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General NPI Number Information
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NPI Number | 1770749525
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Entity Type | Organization
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Legal Business Name | WAYNE H. MARTIN, M.D., INC.
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 1111 GRAND AVE SUITE A
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4171
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Country | US
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Telephone | 909-860-6768
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Fax | 909-860-4224
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Provider Business Mailing Address
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Address Line | 1111 GRAND AVE SUITE A
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4171
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Country | US
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Telephone | 909-860-6768
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Fax | 909-860-4224
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Authorized Official
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Title or Position | PRESIDENT
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Name | WAYNE H. MARTIN
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Credential | M.D.
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Telephone | 909-860-6768
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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 |
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License Number State |
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