Provider Demographics
NPI:1871714683
Name:DANN MARTIN O.D.,P.A.
Entity type:Organization
Organization Name:DANN MARTIN O.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROFESSIONAL ASSOCIATION
Authorized Official - Prefix:DR
Authorized Official - First Name:DANN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PA
Authorized Official - Phone:817-467-2020
Mailing Address - Street 1:5520 S COOPER ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4404
Mailing Address - Country:US
Mailing Address - Phone:817-467-2020
Mailing Address - Fax:817-375-8210
Practice Address - Street 1:5520 S COOPER ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-4404
Practice Address - Country:US
Practice Address - Phone:817-467-2020
Practice Address - Fax:817-375-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04835TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00281UOtherMEDICARE PTAN
TXU46541Medicare UPIN