Provider Demographics
NPI:1366582389
Name:DON P MARTIN OD INC
Entity type:Organization
Organization Name:DON P MARTIN OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:580-223-6780
Mailing Address - Street 1:130 D STREET NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6219
Mailing Address - Country:US
Mailing Address - Phone:580-223-6780
Mailing Address - Fax:580-223-6966
Practice Address - Street 1:130 D STREET NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6219
Practice Address - Country:US
Practice Address - Phone:580-223-6780
Practice Address - Fax:580-223-6966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1053332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$OtherSOCIAL SECURITY NUMBER
OK1932197720OtherNPI