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
1	152W00000X	Optometrist	2117	AR

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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