Provider Demographics
NPI:1083353858
Name:MANUEL, VIRGINIA NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:NICOLE
Last Name:MANUEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 N MAGUIRE ST
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-1420
Mailing Address - Country:US
Mailing Address - Phone:660-747-7300
Mailing Address - Fax:
Practice Address - Street 1:608 N MAGUIRE ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1420
Practice Address - Country:US
Practice Address - Phone:660-747-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022018253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist