Provider Demographics
NPI:1932189438
Name:MARTIN, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2889 10TH AVE N
Mailing Address - Street 2:STE 306
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3045
Mailing Address - Country:US
Mailing Address - Phone:419-693-4444
Mailing Address - Fax:419-697-2149
Practice Address - Street 1:2889 10TH AVE N STE 306
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3045
Practice Address - Country:US
Practice Address - Phone:561-964-0707
Practice Address - Fax:561-293-8330
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142801207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMNODZOtherFLORIDA BLUE ID
FLME142801OtherSTATE LICENSE
OH00638OtherPARAMOUNT
OH728506OtherBUVKEYE
OH000000231232OtherANTHEM
OH1069414OtherUNITED HEALTH CARE
OH35-046428MOtherSTATE OF OHIO LICENSE
OH412029328028OtherCARESOURCE
OH1069414OtherUNITED HEALTH CARE
OH412029328028OtherCARESOURCE
OH$$$$$$$$$016OtherMEDICAL MUTUAL OF OHIO
OH00638OtherPARAMOUNT
OH$$$$$$$$$015OtherMEDICAL MUTUAL OF OHIO
OH$$$$$$$$$011OtherMEDICAL MUTUAL OF OHIO
OHH465033Medicare PIN
OH180045047Medicare PIN
OH$$$$$$$$$014OtherMEDICAL MUTUAL OF OHIO
OH1069414OtherUNITED HEALTH CARE
OH$$$$$$$$$012OtherMEDICAL MUTUAL OF OHIO
OHD31230Medicare UPIN
OH4082215Medicare PIN