Organization
ANTELOPE VALLEY OPTOMETRIC CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY L MARTIN O.D. (CEO)
(661) 942-8437
Entity
Organization
Contact information
Practice address
1745 W AVENUE K, SUITE A, LANCASTER, CA 93534-6501
(661) 942-8437
(661) 940-1959
Mailing address
1745 W AVENUE K, SUITE A, LANCASTER, CA 93534-6501
(661) 942-8437
(661) 940-1959
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
COR 486
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZ40293Z
BLUE CROSS/BLUE SHIELD
CA
Enumeration date
06/12/2006
Last updated
12/09/2008
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