MEDICARE: DR. KRISTA M MARTIN O.D.

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	OD00004067	WA
2	152W00000X	Optometrist	12612	CA

General Provider Information

NPI Number	:	1336242254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTA M MARTIN O.D.

Provider Business Mailing Address
First Line	:	1245 BROAD ST
Second Line	:
City	:	SN LUIS OBISP
State	:	CA
Zip	:	93401-3907
Country	:	US
Telephone Number	:	805-542-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 E MAIN ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-4819
Country	:	US
Telephone Number	:	805-354-6038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	02/26/2019

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