MEDICARE: MARTIN VISION PC

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	1784	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1710947098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN VISION PC

Provider Business Mailing Address
First Line	:	13505 HERRING RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-2946
Country	:	US
Telephone Number	:	719-282-8555
Fax Number	:	718-282-8555

Provider Business Practice Location Address
First Line	:	388 MAIN ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-1713
Country	:	US
Telephone Number	:	719-391-2000
Fax Number	:	844-273-2910

Authorized Official
Title or Position	:	OWNER
Name	:	CYNTHIA MARTIN
Credential	:	OD
Telephone Number	:	719-660-2162

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	05/11/2023

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Directions to “MARTIN VISION PC ” Practice Location

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