Provider Demographics
NPI:1144591173
Name:MANN & MANN OPTOMETRISTS PC
Entity Type:Organization
Organization Name:MANN & MANN OPTOMETRISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:V
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-335-2022
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:NE
Mailing Address - Zip Code:68450-0099
Mailing Address - Country:US
Mailing Address - Phone:402-335-2022
Mailing Address - Fax:402-335-3168
Practice Address - Street 1:512 BELL STREET
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-4445
Practice Address - Country:US
Practice Address - Phone:402-335-2022
Practice Address - Fax:402-335-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS0141OtherRAILROAD MEDICARE PIN
GUSI2D67OtherMUTUAL OF OMAHA
NE06766OtherBLUE CROSS/BLUE SHIELD
2200006OtherUNITED HEALTH CARE
GUSI2D67OtherMUTUAL OF OMAHA
CS0141OtherRAILROAD MEDICARE PIN
2200006OtherUNITED HEALTH CARE
092201Medicare PIN