Provider Demographics
NPI:1083328439
Name:MANILA OPTICAL INC
Entity Type:Organization
Organization Name:MANILA OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VENERANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GATDULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-469-7690
Mailing Address - Street 1:94-340 WAIPAHU DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3006
Mailing Address - Country:US
Mailing Address - Phone:808-671-1234
Mailing Address - Fax:
Practice Address - Street 1:94-340 WAIPAHU DEPOT ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3006
Practice Address - Country:US
Practice Address - Phone:808-671-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty