MEDICARE: LINDSEY DENISON 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	8071	TX
2	152W00000X	Optometrist	8071TG	TX

General Provider Information

NPI Number	:	1659623056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY DENISON MARTIN O.D

Provider Business Mailing Address
First Line	:	810 KNIGHTS CROSS DR STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2981
Country	:	US
Telephone Number	:	210-495-9020
Fax Number	:	210-495-9398

Provider Business Practice Location Address
First Line	:	19202 STONE OAK PKWY
Second Line	:	STE 106
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3286
Country	:	US
Telephone Number	:	210-495-9020
Fax Number	:	210-495-9398

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

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	12/19/2018

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