Individual
DR. FREDERICK WARREN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD3266
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000624846
HUMANA
—
01
—
01257740
AMERIGROUP
—
05
—
1760573497
—
KY
01
—
406171015
RAILROAD MEDICARE
KY
05
—
4599125
—
TN
01
—
4619
AVESIS/MEDICAID
KY
01
—
49606
BCBSTN/BLUECARE/TENNCARE
—
05
—
77008167
—
KY
Enumeration date
06/22/2005
Last updated
12/03/2019
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