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Individual
DR. MARTIN ALAN KANSOL
Active
Individual
DR. MARTIN ALAN KANSOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC002152
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078422200
—
FL
01
—
592903075
TAX ID
FL
01
—
OPC002152
FL OPTOMETRY LICENSE
FL
Enumeration date
03/19/2007
Last updated
05/08/2009
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