Provider Demographics
NPI:1699868588
Name:MARTINKUS, GARY J (OD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:MARTINKUS
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 1:3907 CASTLEVALE RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7802
Mailing Address - Country:US
Mailing Address - Phone:509-248-5378
Mailing Address - Fax:
Practice Address - Street 1:3907 CASTLEVALE RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7802
Practice Address - Country:US
Practice Address - Phone:509-248-5378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00000922152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2416808Medicaid
WAG000119518Medicare PIN
WA2416808Medicaid
WA0299680002Medicare NSC