Provider Demographics
NPI:1528639770
Name:MARTINEZ GARCIA, VICTOR (OD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:MARTINEZ GARCIA
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 1:3206 RAMBLEWOOD DR N # 18D4
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3812
Mailing Address - Country:US
Mailing Address - Phone:194-158-6121
Mailing Address - Fax:
Practice Address - Street 1:14901 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1801
Practice Address - Country:US
Practice Address - Phone:813-960-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5962152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist