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General NPI Number Information
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NPI Number | 1992974760
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Entity Type | Organization
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Legal Business Name | STANLEY R MARTIN, O.D.
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 09/25/2013
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Provider Practice Location Address
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Address Line | 231 NORTHGATE DR STE 106
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City | MC MINNVILLE
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State | TN
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Zip | 37110-1436
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Country | US
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Telephone | 931-473-1986
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Fax | 931-473-1334
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Provider Business Mailing Address
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Address Line | 231 NORTHGATE DR STE 106
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City | MC MINNVILLE
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State | TN
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Zip | 37110-1436
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Country | US
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Telephone | 931-473-1986
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Fax | 931-473-1334
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Authorized Official
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Title or Position | OWNER
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Name | DR. STANLEY R MARTIN
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Credential | O.D.
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Telephone | 931-473-1986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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