Active NPI
Jerry Lee Martin, O.D.
- Optometrist
- Lancaster, CA
National Provider Identifier
1679543821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT6288TPL
- Practice address
- 1745 W Avenue K
Lancaster, CA 93534-6502 - Phone
- (661) 942-8437
- Fax
- (661) 940-1959
- NPI assigned
- Jan 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT6288TPL | CA | Primary |
| Corneal and Contact Management Optometrist | 152WC0802X | OPT6288TPL | CA |
Addresses
Primary practice location
1745 W Avenue K
Lancaster, CA 93534-6502
Mailing address
1745 W Avenue K
Lancaster, CA 93534-6502
Phone (661) 942-8437
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6169 | Other | CA | MESC PROVIDER NUMBER |
| ZZ40293Z | Other | CA | B/C B/S GROUP IDENTIFIER |
| 2673 | Other | CA | DAVIS VISION PROVIDER NUM |
| 410016191 | Other | CA | RAILROAD MEDICARE NUMBER |
| SD0062880 | Other | CA | B/C B/S IDENTIFIER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT6288TPL | CA | MD | Corneal and Contact Management Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235088000000",
"number": "1679543821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1745 W AVENUE K",
"city": "LANCASTER",
"state": "CA",
"postal_code": "935346502",
"telephone_number": "661-942-8437",
"fax_number": "661-940-1959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1745 W AVENUE K",
"city": "LANCASTER",
"state": "CA",
"postal_code": "935346502",
"telephone_number": "661-942-8437",
"fax_number": "661-940-1959"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "JERRY",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-23",
"last_updated": "2009-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT6288TPL",
"primary": true
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "CA",
"license": "OPT6288TPL",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MESC PROVIDER NUMBER",
"identifier": "6169",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "B/C B/S GROUP IDENTIFIER",
"identifier": "ZZ40293Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAVIS VISION PROVIDER NUM",
"identifier": "2673",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE NUMBER",
"identifier": "410016191",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "B/C B/S IDENTIFIER",
"identifier": "SD0062880",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.