MEDICARE: RANDY M MARTINELLI L.D.O.

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	156FX1800X	Optician	FL3876	FL

General Provider Information

NPI Number	:	1598821902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY M MARTINELLI L.D.O.

Provider Business Mailing Address
First Line	:	5062 WEST ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8129
Country	:	US
Telephone Number	:	561-498-8884
Fax Number	:	561-498-7878

Provider Business Practice Location Address
First Line	:	2514 PGA BLVD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2902
Country	:	US
Telephone Number	:	561-500-8884
Fax Number	:	561-500-8885

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	03/17/2018

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