Individual
DR. DUSTAN CHRIS MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
812 S VAN BUREN RD, EDEN, NC 27288-5324
(336) 623-2020
Mailing address
1950 OLD GALLOWS RD, SUITE 520, VIENNA, VA 22182-3990
(703) 847-8899
(703) 991-0514
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618001304
VA
152W00000X
Optometrist
Primary
1895
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093MO
BCBS PROVIDER NUMBER
NC
05
—
89093MO
—
NC
Enumeration date
08/09/2005
Last updated
03/17/2018
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