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General NPI Number Information
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NPI Number | 1790189397
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Entity Type | Organization
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Legal Business Name | DR. JENNIFER MARTINO, OPTOMETRIST
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Dates
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Enumeration Date | 10/10/2014
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 4096 N FOSTER RD
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City | SAN ANTONIO
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State | TX
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Zip | 78244-1874
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Country | US
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Telephone | 210-661-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 374
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City | CONVERSE
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State | TX
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Zip | 78109-0374
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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 | OD/OWNER
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Name | JENNIFER MARTINO
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Credential |
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Telephone | 210-606-4988
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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 | 6482T
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License Number State | TX
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