Provider Demographics
NPI:1316977051
Name:STEFANI S. MARTIN, OD PA
Entity type:Organization
Organization Name:STEFANI S. MARTIN, OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANI
Authorized Official - Middle Name:SAYERS
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-265-2020
Mailing Address - Street 1:1155 E ATLANTIC AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-6972
Mailing Address - Country:US
Mailing Address - Phone:561-265-2020
Mailing Address - Fax:561-258-0141
Practice Address - Street 1:1155 E ATLANTIC AVE
Practice Address - Street 2:STE 104
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6972
Practice Address - Country:US
Practice Address - Phone:561-265-2020
Practice Address - Fax:561-258-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0407Medicare PIN