MEDICARE: JESUS GABRIEL MARTINEZ 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	1010	NV

General Provider Information

NPI Number	:	1942754155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS GABRIEL MARTINEZ OD

Provider Business Mailing Address
First Line	:	3515 SAINT ROSE PKWY STE 110
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4596
Country	:	US
Telephone Number	:	702-848-3387
Fax Number	:	702-848-3778

Provider Business Practice Location Address
First Line	:	3515 SAINT ROSE PKWY STE 110
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4596
Country	:	US
Telephone Number	:	702-848-3387
Fax Number	:	702-848-3778

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

Provider Enumeration Date	:	08/05/2016
Last Update Date	:	12/22/2021

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