Provider Demographics
NPI:1215242300
Name:MARTIN, HERLYNNE (OD)
Entity type:Individual
Prefix:DR
First Name:HERLYNNE
Middle Name:
Last Name:MARTIN
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 1:9617 N METRO PKWY W
Mailing Address - Street 2:STE. 1000
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1400
Mailing Address - Country:US
Mailing Address - Phone:602-678-4395
Mailing Address - Fax:602-678-7064
Practice Address - Street 1:9617 N METRO PKWY W
Practice Address - Street 2:STE. 1000
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1400
Practice Address - Country:US
Practice Address - Phone:602-678-4395
Practice Address - Fax:602-678-7064
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD730152W00000X
AZ1973152W00000X
OH5999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIFC547ZMedicare PIN