Individual
SAMUEL A. MARTIN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
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
Update your record
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