# DR. MARTIN ALAN KANSOL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1235253725
- **Gender:** Man
- **Credential:** O.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC002152 | FL | Yes |

## Other

- **Enumeration date:** 03/19/2007
- **Last updated:** 05/08/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 078422200 | — | FL |
| 01 | — | 592903075 | TAX ID | FL |
| 01 | — | OPC002152 | FL OPTOMETRY LICENSE | FL |