Provider Demographics
NPI:1114988862
Name:MANCIL, GARY LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:MANCIL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 EASTLAND LN
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-8131
Mailing Address - Country:US
Mailing Address - Phone:704-279-9126
Mailing Address - Fax:
Practice Address - Street 1:1601 BRENNER AVE
Practice Address - Street 2:HEFNER VA MEDICAL CENTER (11-I)
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2515
Practice Address - Country:US
Practice Address - Phone:704-638-9000
Practice Address - Fax:704-638-3868
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1052152WL0500X
TN871152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation