Marten-Ellis, Geronimo

Marten-Ellis, Geronimo is an sole proprietor health care provider with primary practice located at 620-C Ft.Hood.Rd. , Killeen TX 76541. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Marten-Ellis, Geronimo can be contacted via phone (254) 200-1010.

Contact Information

Primary practice address
620-C Ft.Hood.Rd. Killeen TX 76541
Fax: (254) 213-9315
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2930T Texas

Profile Details

NPI number 1467538322
LBN Legal business name Marten-Ellis, Geronimo
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 31st, 2006
Last updated Jan 27th, 2010 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467538322 NPPES
Texas Other 19823 SUPERIOR HEALTH PLAN
Texas Other 751861475 SUPERIOR HEALTH PLAN
Texas Other 00E83Z SUPERIOR HEALTH PLAN
Texas MEDICAID 019810301 SUPERIOR HEALTH PLAN
Texas Other 55635 SUPERIOR HEALTH PLAN
Texas Other 128218100 SUPERIOR HEALTH PLAN
Texas Other 286426 SUPERIOR HEALTH PLAN
Texas Other 751861475 SUPERIOR HEALTH PLAN
Texas Other 930417 SUPERIOR HEALTH PLAN

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