Provider Demographics
NPI:1114579992
Name:ROMAN, MARTA (OD)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7913 ALLISON WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-4450
Mailing Address - Country:US
Mailing Address - Phone:303-424-5282
Mailing Address - Fax:
Practice Address - Street 1:7913 ALLISON WAY STE 102
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-4450
Practice Address - Country:US
Practice Address - Phone:303-424-5282
Practice Address - Fax:303-424-8291
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2693152W00000X
CO3980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTA2693OtherSTATE LICENSE
CO3980OtherSTATE LICENSE