Provider Demographics
NPI:1548817786
Name:MARTINEZ, CHRISTINA ANN (OD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 SWANSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5991
Mailing Address - Country:US
Mailing Address - Phone:928-855-5026
Mailing Address - Fax:
Practice Address - Street 1:2277 SWANSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5991
Practice Address - Country:US
Practice Address - Phone:928-855-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT002376152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist