Provider Demographics
NPI:1487705737
Name:HELLMAN, MARTIN L (OD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:L
Last Name:HELLMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SALEM TPKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-6516
Mailing Address - Country:US
Mailing Address - Phone:860-889-2020
Mailing Address - Fax:860-889-6597
Practice Address - Street 1:22 SALEM TPKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6516
Practice Address - Country:US
Practice Address - Phone:860-889-2020
Practice Address - Fax:860-889-6597
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001018152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004052965Medicaid
CT004052965Medicaid
CTT22052Medicare UPIN