1437318391 NPI number — BURKE D. MARTIN, OD

Table of content: (NPI 1437318391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437318391 NPI number — BURKE D. MARTIN, OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURKE D. MARTIN, OD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437318391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1308 ARRONIMINK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-6303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-785-0624
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 S I H 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78664-7320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-388-2600
Provider Business Practice Location Address Fax Number:
512-388-0854
Provider Enumeration Date:
06/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
LYNNE
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
OPTOMETRIST/BOOKKEEPER
Authorized Official Telephone Number:
512-785-0624

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  5141T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , with the licence number: 5141T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 5141T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64765 . This is a "SAFEGUARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 49292 & 47839 . This is a "DAVIS VISION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 019327801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020635 & 024923 . This is a "BLOCK VISION (CHIP AND AMERIGROUP)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 13860 & 35403 . This is a "AVESIS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2600 . This is a "MEDICAL EYE SERVICE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 19973 & 26903 . This is a "SPECTERA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 550475 &545480 . This is a "NATIONAL VISION ADMINISTRATORS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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