Basic Information
| Provider Information | |||||||||
| NPI: | 1255304754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 VERDE VALLEY SCHOOL ROAD | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | SEDONA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282399901 | ||||||||
| FaxNumber: | 9282399902 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 VERDE VALLEY SCHOOL ROAD | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | SEDONA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282399901 | ||||||||
| FaxNumber: | 9282399902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 03/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1467 | AZ | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.