Individual
MRS. MICHELLE MARIE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
12750 BASS LAKE RD, MAPLE GROVE, MN 55369-6307
(763) 553-1811
(763) 553-0131
Mailing address
12750 BASS LAKE RD, MAPLE GROVE, MN 55369-6307
(763) 553-1811
(763) 553-0131
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3053
MN
Other
Enumeration date
08/03/2006
Last updated
09/12/2008
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