Provider Demographics
NPI:1043066657
Name:MARTINEZ, PETER (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090B HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2613
Mailing Address - Country:US
Mailing Address - Phone:516-358-4040
Mailing Address - Fax:516-358-7465
Practice Address - Street 1:2090B HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2613
Practice Address - Country:US
Practice Address - Phone:516-358-4040
Practice Address - Fax:516-358-7465
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007944-01156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician