Individual
SAMUEL A. MARTIN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
201 A ST, FARMVILLE, VA 23901-1613
(434) 392-8355
(434) 392-3042
Mailing address
PO BOX 308, FARMVILLE, VA 23901-0308
(434) 392-8355
(434) 392-3042
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000089
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009203095
—
VA
01
—
0225110001
DME MEDICARE
VA
01
—
075554
BCBS
VA
01
—
540001094
RR MEDICARE
VA
01
—
6271
DAVIS VISION
VA
Enumeration date
07/19/2006
Last updated
08/25/2010
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