Vivian L Martin

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

VIVIAN L MARTIN

Doing business as

Parkway Shoe Repair Service

Practice address

1024 Jordan St
Mount Vernon, IL 62864-4231

Phone

(618) 242-4442

Fax

(618) 242-3942

NPI assigned

Oct 18, 2012

Last updated

Oct 18, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vivian Lea Martin

Title

Owner

Phone

(618) 242-4442

Specialties & licenses 1

Addresses

Other names 1

• Parkway Shoe Repair Service Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mario Donald Hodge, C.PED

  • Pedorthist
  • Mount Vernon, IL
  • NPI 1023369501
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350518400000",
    "number": "1194078816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 JORDAN ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628644231",
            "telephone_number": "618-242-4442",
            "fax_number": "618-242-3942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 JORDAN ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628644231",
            "telephone_number": "618-242-4442",
            "fax_number": "618-242-3942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVIAN L MARTIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-18",
        "last_updated": "2012-10-18",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_middle_name": "LEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-242-4442"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkway Shoe Repair Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• James Brian Verges, CADC
• Trinidad Maria Vicente, MHP
• Wal-Mart Stores, Inc (Vision Center 30-0224)
• Walgreen Co (Walgreens #02876)
• Walgreen Co. (Walgreens #5995)
• Erin Melissa Wallace, BS/CADC
• Annette Walls, MAPC

• Prosthetic/Orthotic Supplier in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Prosthetic/Orthotic Supplier in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.