Provider Demographics
NPI:1871871939
Name:SAMSON, JAMIE MARTINEZ (OD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARTINEZ
Last Name:SAMSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:SAMSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6843 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4280
Mailing Address - Country:US
Mailing Address - Phone:520-888-0099
Mailing Address - Fax:520-888-7929
Practice Address - Street 1:6843 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4280
Practice Address - Country:US
Practice Address - Phone:520-888-0099
Practice Address - Fax:520-888-7929
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010481152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ768754Medicaid
AZ92567Medicare PIN