Provider Demographics
NPI:1962288290
Name:MARTIN, CHONA
Entity type:Individual
Prefix:
First Name:CHONA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 LEE ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-8533
Mailing Address - Country:US
Mailing Address - Phone:919-210-6816
Mailing Address - Fax:
Practice Address - Street 1:5141 NC HIGHWAY 42 W
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-8418
Practice Address - Country:US
Practice Address - Phone:919-772-7073
Practice Address - Fax:919-772-7660
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1152156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician