Frederick Warren Martin, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD3266 Issued in TN

Practice address

467 Sunset TRL
Jellico, TN 37762-2709

Phone

(423) 784-2020

Fax

(423) 784-4940

NPI assigned

Jun 22, 2005

Last updated

Dec 3, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575331200000",
    "number": "1245236496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306",
            "city": "FERGUSON",
            "state": "KY",
            "postal_code": "425330306",
            "telephone_number": "606-492-2211",
            "fax_number": "606-676-0873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "467 SUNSET TRL",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377622709",
            "telephone_number": "423-784-2020",
            "fax_number": "423-784-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "FREDERICK",
        "middle_name": "WARREN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2019-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD3266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77008167",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01257740",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4599125",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS/MEDICAID",
            "identifier": "4619",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTN/BLUECARE/TENNCARE",
            "identifier": "49606",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760573497",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "000624846",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "406171015",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "COMPULINK",
            "affiliation": "N",
            "endpointDescription": "SECURE SOFTWARE",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ELECTRONIC HEALTH RECORDS",
            "address_1": "467 Sunset Trl",
            "city": "Jellico",
            "state": "TN",
            "country_code": "US",
            "postal_code": "377622709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• JLC Beechtree Inc
• Kabir Clinic LLC
• Mohammed Humayun Kabir, MD
• Suzanne Musick Kitts, PHARMD
• Terrence Wesley Leveck, MD
• Cynthia Ann Mason, LPC-MHSP
• Maximum Potential Physical Therapy, PLLC
• Memorial Hospital, Inc. (Sunbelt Homecare)
• Natalie Sue Nantz, PHARMD
• North Campbell Community Hospital Inc

• Optometrist in Jellico, TN
• Providers in Jellico, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2019; 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.