Individual
MICHAEL MARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6525 S STATE ST, C/O OPTICAL, MURRAY, UT 84107-7218
(801) 685-7989
(801) 685-9105
Mailing address
13489 CORNER BRIDGE LN, DRAPER, UT 84020-7803
(801) 572-9789
(801) 685-9105
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2774349934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87017934007001
BLUE CROSS/BLUE SHIELD
UT
05
—
999000797009
—
UT
Enumeration date
10/10/2005
Last updated
04/22/2008
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