Provider Demographics
NPI:1215088125
Name:MARTINEK, ANGELA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:MARTINEK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 N ELM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2599
Mailing Address - Country:US
Mailing Address - Phone:336-271-2020
Mailing Address - Fax:336-275-8200
Practice Address - Street 1:3610 N ELM ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2599
Practice Address - Country:US
Practice Address - Phone:336-271-2020
Practice Address - Fax:336-275-8200
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1622152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890926UMedicaid
NC890926UMedicaid
NC2470692Medicare ID - Type Unspecified