Individual
DR. DUSTIN EUGENE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1223 N ROCK RD, BLDG C, WICHITA, KS 67206-1269
(316) 634-2020
Mailing address
1223 N ROCK RD, BLDG C, WICHITA, KS 67206-1269
(316) 634-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1814
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200655320A
—
KS
Enumeration date
08/28/2008
Last updated
10/14/2010
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