Provider Demographics
NPI:1992974760
Name:STANLEY R MARTIN, O.D.
Entity type:Organization
Organization Name:STANLEY R MARTIN, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-473-1986
Mailing Address - Street 1:231 NORTHGATE DR STE 106
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1436
Mailing Address - Country:US
Mailing Address - Phone:931-473-1986
Mailing Address - Fax:931-473-1334
Practice Address - Street 1:231 NORTHGATE DR STE 106
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1436
Practice Address - Country:US
Practice Address - Phone:931-473-1986
Practice Address - Fax:931-473-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1253720001Medicare NSC