Provider Demographics
NPI:1043486905
Name:MARTINS FINE EYEWEAR INC
Entity type:Organization
Organization Name:MARTINS FINE EYEWEAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOGN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:206-363-6003
Mailing Address - Street 1:1536 N 115TH ST
Mailing Address - Street 2:#110
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8400
Mailing Address - Country:US
Mailing Address - Phone:206-363-6003
Mailing Address - Fax:206-363-6004
Practice Address - Street 1:1536 N 115TH ST
Practice Address - Street 2:#110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8400
Practice Address - Country:US
Practice Address - Phone:206-363-6003
Practice Address - Fax:206-363-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2073401Medicaid
0221510001Medicare PIN