Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant | 134435 | TX |
NPI | 1871701946 |
---|---|
Provider Name | Amber Lynn Martin |
First Address | Devine, TX 78016-4633 |
Second Address | Lackland A F B, TX 78236-9907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2007 |
Last Update Date | 08/07/2007 |