Provider Demographics
NPI:1215939988
Name:MARTIN, NICK G (OD)
Entity type:Individual
Prefix:DR
First Name:NICK
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:7021 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2075
Mailing Address - Country:US
Mailing Address - Phone:918-250-6766
Mailing Address - Fax:918-250-8246
Practice Address - Street 1:7021 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2025
Practice Address - Country:US
Practice Address - Phone:918-250-6766
Practice Address - Fax:918-250-8246
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist