NPIMap

Organization Active NPI

Dr Martinez OD, PLLC

  • Optometrist
  • Henderson, NV
National Provider Identifier
1366040305
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DR MARTINEZ OD, PLLC
Practice address
3515 Saint Rose Pkwy Ste 110
Henderson, NV 89052-4596
Phone
(702) 848-3387
Fax
(702) 848-3387
NPI assigned
Oct 13, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Authorized official

Name
Dr. Jesus Gabriel Martinez, ODNPI 1942754155
Title
Manager
Phone
(702) 848-3387

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

3515 Saint Rose Pkwy Ste 110
Henderson, NV 89052-4596

Mailing address

3515 Saint Rose Pkwy Ste 110
Henderson, NV 89052-4596
Phone (702) 848-3387

Other names 1

  • St. Rose Eye Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201027001207 NV Part B Supplier - Clinic/Group Practice 6305266693 Receives reassigned benefits from 2 practitioners
Practice locations: Henderson, NV

National Provider Directory

National Provider Directory

Locations

3515 Saint Rose Pkwy
Ste 110
Henderson, NV 89052
Phone (702) 848-3387

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640131200000",
    "number": "1366040305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 SAINT ROSE PKWY STE 110",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524596",
            "telephone_number": "702-848-3387",
            "fax_number": "702-848-3778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 SAINT ROSE PKWY STE 110",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524596",
            "telephone_number": "702-848-3387",
            "fax_number": "702-848-3387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR MARTINEZ OD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-13",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "JESUS",
        "authorized_official_middle_name": "GABRIEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-848-3387",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Rose Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Rose Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.