Individual
DR. MARTIN ALAN KANSOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3098 W LAKE MARY BLVD, LAKE MARY, FL 32746-6742
(407) 321-6434
Mailing address
3098 W LAKE MARY BLVD, LAKE MARY, FL 32746-6742
(407) 321-6434
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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