| Doctor Name: | MR. DAVID A MARTIN |
| NPI Number: | 1164629572 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OPTICIAN |
| License Number: | 31TD00065100 |
| Business Practice Address: | 379 Franklin Ave Wyckoff, NJ - 074811966 |
| Business Phone Number: | 2018911200 |
| Business Fax Number: | 2018914306 |
| Mailing Address: | 379 Franklin Ave, WYCKOFF |
| State: | NJ |
| Postal Code: | 074811966 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/29/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 31TD00065100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |