Provider Demographics
NPI:1215800024
Name:MARTINEZ, MARVIN ROMEO
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:ROMEO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 BROADWAY BLVD STE 137
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:214-501-2765
Practice Address - Street 1:3161 BROADWAY BLVD STE 137
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1528
Practice Address - Country:US
Practice Address - Phone:562-261-7542
Practice Address - Fax:214-501-2765
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43716156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty