MEDICARE: JAMIE MARTINEZ SAMSON OD

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	046010481	IL

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

General Provider Information

NPI Number	:	1871871939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE MARTINEZ SAMSON OD

Provider Business Mailing Address
First Line	:	6843 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-4280
Country	:	US
Telephone Number	:	520-888-0099
Fax Number	:	520-888-7929

Provider Business Practice Location Address
First Line	:	6843 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-4280
Country	:	US
Telephone Number	:	520-888-0099
Fax Number	:	520-888-7929

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

Provider Enumeration Date	:	07/22/2011
Last Update Date	:	08/09/2022

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