Provider Demographics
NPI:1093011058
Name:DAVID MANNING, OD, PA
Entity Type:Organization
Organization Name:DAVID MANNING, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-851-2170
Mailing Address - Street 1:1700 CLUB MANOR DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7400
Mailing Address - Country:US
Mailing Address - Phone:501-851-2170
Mailing Address - Fax:501-851-2537
Practice Address - Street 1:1700 CLUB MANOR DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7400
Practice Address - Country:US
Practice Address - Phone:501-851-2170
Practice Address - Fax:501-851-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR189259722Medicaid
AR189259722Medicaid
AR5G856Medicare PIN
ARDS2803Medicare PIN