MEDICARE: DR. STACY MARTINSON 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	0618001680	VA

General Provider Information

NPI Number	:	1699968966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY MARTINSON O.D.

Provider Business Mailing Address
First Line	:	1098 FREDERICK BLVD
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-4119
Country	:	US
Telephone Number	:	215-694-9388
Fax Number	:

Provider Business Practice Location Address
First Line	:	4665 SOUTH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1055
Country	:	US
Telephone Number	:	757-461-0050
Fax Number	:

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

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	06/26/2019

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