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General NPI Number Information
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NPI Number | 1881618445
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Entity Type | Individual
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Provider Name | CHRISTOPHER DALE MARTIN II O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 4200 S ASHLAND AVE UNIT 255
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City | CHICAGO
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State | IL
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Zip | 60609-2306
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Country | US
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Telephone | 708-477-1986
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Fax |
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Provider Business Mailing Address
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Address Line | 6541 27TH PL
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City | BERWYN
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State | IL
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Zip | 60402-2769
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Country | US
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Telephone | 708-477-1986
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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 | 046-009427
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License Number State | IL
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