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NPI Code Detail

MEDICARE: ROBERT EDWARD MARTIN

MEDICARE: ROBERT EDWARD MARTIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2117AR

General Provider Information

NPI Number : 1154590586
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT EDWARD MARTIN
Provider Business Mailing Address
First Line : 834 W NORTH ST
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72701-1866
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 834 W NORTH ST
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72701-1866
Country : US
Telephone Number : 479-442-8961
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ROBERT EDWARD MARTIN
Credential :
Telephone Number : 479-442-8961
Provider Enumeration Date : 02/29/2008
Last Update Date : 02/29/2008

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Directions to “ROBERT EDWARD MARTIN ” Practice Location

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