MEDICARE: CHRISTOPHER DALE MARTIN II 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	046-009427	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	502720039	OTHER	IL	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1881618445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER DALE MARTIN II O.D.

Provider Business Mailing Address
First Line	:	6541 27TH PL
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-2769
Country	:	US
Telephone Number	:	708-477-1986
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 S ASHLAND AVE UNIT 255
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-2306
Country	:	US
Telephone Number	:	708-477-1986
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/14/2025

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