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Tina C. Martin, O.D.

Optometrist in Midvale, UT. Individual provider (NPI-1).

NPI number1821189689
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1821189689
Entity type
Individual (NPI-1)
Name
Tina C. Martin
Credential
O.D.
Sex
Female
Sole proprietor
No
Enumeration date
Sep 27, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X Optometrist1112889934UTYes

Practice location

914 Fort Union Blvd
Midvale, UT 84047-1714

Phone 801-561-4282 · Fax 801-561-4283

Mailing address

914 Fort Union Blvd
Midvale, UT 84047-1714

Phone 801-561-4282 · Fax 801-561-4283

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