Provider Demographics
NPI:1992938922
Name:MARTIN EYE CARE PLLC
Entity type:Organization
Organization Name:MARTIN EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:V
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-754-0110
Mailing Address - Street 1:110 S GREENVILLE WEST DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-3560
Mailing Address - Country:US
Mailing Address - Phone:616-754-0110
Mailing Address - Fax:616-754-4733
Practice Address - Street 1:110 S GREENVILLE WEST DR
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-3560
Practice Address - Country:US
Practice Address - Phone:616-754-0110
Practice Address - Fax:616-754-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6377850001Medicare NSC
MIDP3696Medicare PIN
MIMO2720001Medicare PIN
MIU58374Medicare UPIN