Individual
DR. FREDERICK WARREN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
467 SUNSET TRL, JELLICO, TN 37762-2709
(423) 784-2020
(423) 784-4940
Mailing address
PO BOX 306, FERGUSON, KY 42533-0306
(606) 492-2211
(606) 676-0873
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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