Individual
MARTHA CANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
1440 BROADWAY # 10826, NEW YORK, NY 10018-2301
(212) 221-3844
Mailing address
11605 N LAMAR BLVD, AUSTIN, TX 78753-2658
(737) 222-6996
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
009898
NY
Other
Enumeration date
03/19/2020
Last updated
03/19/2020
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