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DR. MARTIN ALAN KANSOL O.D.

>> Optometrist >> Eye and Vision Services Providers

Registrant NPI Number: 1235253725

Individual Registrant:
DR. MARTIN ALAN KANSOL O.D.
Gender: M
Sole Proprietor

Location and contact information for practice:
3098 W LAKE MARY BLVD  LAKE MARY, FL 32746-6742 US
Tel: 407-321-6434  Fax: --

Contact information for business:
3098 W LAKE MARY BLVD  LAKE MARY, FL 32746-6742 US
Tel: 407-321-6434  Fax: --

Registration Information:
NPI: 1235253725
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
Optometrist
FLOPC002152

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
FL OPTOMETRY LICENSEOPC002152FL01
078422200FL05
TAX ID592903075FL01




HEALTH CARE JOBS FL - Page 1



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