Individual
DR. GERONIMO MARTEN-ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
620-C FT.HOOD.RD., KILLEEN, TX 76541
(254) 200-1010
(254) 213-9315
Mailing address
PO BOX 2020, HARKER HEIGHTS, TX 76548-0020
(254) 200-1010
(254) 213-9315
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2930T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00E83Z
BLUE CROSS/BLUE SHIELD TX
TX
05
—
019810301
—
TX
01
—
128218100
FIRSTCARE
TX
01
—
19823
SUPERIOR HEALTH PLAN
TX
01
—
286426
SCOTT&WHITE
TX
01
—
55635
SAFEGUARD
TX
01
—
751861475
ITPE
TX
01
—
930417
COLE VISION/EYEMED
TX
Enumeration date
10/31/2006
Last updated
01/27/2010
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