Martell Eyecare, LLC
Organization Active NPI Optometrist · Marathon, WI
NPI 1952962763 · NPPES record last updated Jan 1, 2020
Key facts
- NPI
- 1952962763
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- MARTELL EYECARE, LLC
- Practice address
- 703 Third Street
Marathon, WI 54448 - Phone
- (715) 870-1454
- NPI assigned
- Jun 23, 2019
- Organization subpart
- No
Authorized official
- Name
- Ken Martell, OD
- Title
- Owner
- Phone
- (715) 870-1454
Practitioners 4
-
Ken Martell, OD
-
Erin Leigh Goga, O.D.
-
Raymond M Goga, OD
-
Yaser Haleem, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190724001654 | WI | Part B Supplier - Clinic/Group Practice | 1355677634 |
Receives reassigned benefits from 1 practitioner Practice locations: Wittenberg, WI; Marathon, WI |
National Provider Directory
Locations
703 3rd St
Marathon, WI 54448
Phone (715) 443-2248
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes | ||
| Eyewear Supplier | 332H00000X |
Addresses
Primary practice location
703 Third Street
Marathon, WI 54448
Mailing address
322 Ross Ave
Wausau, WI 54403
Phone (715) 870-1454
Other practice location 1
601 S Webb St
Wittenberg, WI 54499-9042
Phone (715) 253-2157
Other providers in Marathon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.