Provider Demographics
NPI:1124460837
Name:MARTORANA, MICHAEL C (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:MARTORANA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1155
Mailing Address - Country:US
Mailing Address - Phone:502-915-7794
Mailing Address - Fax:
Practice Address - Street 1:1562 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1155
Practice Address - Country:US
Practice Address - Phone:502-915-7794
Practice Address - Fax:844-715-7924
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1928DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK112101Medicare PIN