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NPI Code Detail

MEDICARE: RICHARD DANE MARTIN OD

MEDICARE: RICHARD DANE MARTIN OD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2152W00000XOptometrist3680-35WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215516646
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD DANE MARTIN OD
Provider Business Mailing Address
First Line : 7974 UW HEALTH CT
Second Line :
City : MIDDLETON
State : WI
Zip : 53562-5531
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 S PARK ST
Second Line :
City : MADISON
State : WI
Zip : 53715-1375
Country : US
Telephone Number : 608-916-2020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2021
Last Update Date : 05/04/2026

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