Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 18003118A | IN |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 18003118A | IN |
NPI | 1003921487 |
---|---|
Provider Name | Richard Lee Martin JR. |
First Address | Greencastle, IN 46135-1105 |
Second Address | Terre Haute, IN 47803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 12/11/2009 |