Basic Information
| Provider Information | |||||||||
| NPI: | 1326063702 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AVILES | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 MILLER CIR | ||||||||
| Address2: | |||||||||
| City: | ARMONK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105041361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128616200 | ||||||||
| FaxNumber: | 2122886545 | ||||||||
| Practice Location | |||||||||
| Address1: | 229 E 79TH ST | ||||||||
| Address2: | SUITE 1L | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100210866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128616200 | ||||||||
| FaxNumber: | 2122886545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | VUT005050-1 | NY | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 5173906 | 01 | NY | DAVIS VISION | OTHER | 926275 | 01 | NY | BLOCK VISION | OTHER | 2023167 | 01 | NY | UNITED HEALTHCARE | OTHER | 3C9951 | 01 | NY | HEALTHNET | OTHER |