Serge Martin Enterprises Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

880 Issued in TN

Legal business name

SERGE MARTIN ENTERPRISES INC

Practice address

2361 Memorial Blvd
Murfreesboro, TN 37129-5108

Phone

(615) 896-0082

Fax

(615) 896-9551

NPI assigned

Apr 14, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Serge B Martin, O.D.

Title

President

Phone

(615) 896-0082

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224806400000",
    "number": "1356515159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2361 MEMORIAL BLVD",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371295108",
            "telephone_number": "615-896-0082",
            "fax_number": "615-896-9551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2361 MEMORIAL BLVD",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371295108",
            "telephone_number": "615-896-0082",
            "fax_number": "615-896-9551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERGE MARTIN ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2008-10-24",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "SERGE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-896-0082",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1356515159",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2008; 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.