Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Vivian L Martin

Organization Prosthetic/Orthotic Supplier · NPI 1194078816

Vivian L Martin is a Prosthetic/Orthotic Supplier in Mount Vernon, Illinois. Registered with an NPI since 2012.

In the registry since
2012

Practice location Address checks out

1024 Jordan St
Mount Vernon, IL 62864-4231
Phone: (618) 242-4442
Fax: (618) 242-3942
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Prosthetic/Orthotic Supplier (primary) Taxonomy 335E00000X

Record details

NPI number1194078816
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Vivian Martin — Owner · (618) 242-4442
Other names Parkway Shoe Repair Service
NPI enumeratedOctober 18, 2012
Last updated in NPPESOctober 18, 2012
Mailing address1024 Jordan St, Mount Vernon, IL 62864-4231