Individual
CHRISTOPHER DALE MARTIN II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4200 S ASHLAND AVE UNIT 255, CHICAGO, IL 60609-2306
(708) 477-1986
Mailing address
6541 27TH PL, BERWYN, IL 60402-2769
(708) 477-1986
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009427
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009427
—
IL
01
—
502720039
MEDICARE PTAN
IL
Enumeration date
07/27/2006
Last updated
10/14/2025
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