Provider Demographics
NPI:1164820932
Name:MANN EYE CENTER, PA
Entity Type:Organization
Organization Name:MANN EYE CENTER, PA
Other - Org Name:MANN EYE 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-275-2457
Mailing Address - Street 1:PO BOX 659506
Mailing Address - Street 2:DEPT 2181
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-9506
Mailing Address - Country:US
Mailing Address - Phone:713-275-2461
Mailing Address - Fax:713-275-2496
Practice Address - Street 1:10223 BROADWAY ST
Practice Address - Street 2:SUITE J
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7880
Practice Address - Country:US
Practice Address - Phone:281-971-9333
Practice Address - Fax:281-971-9338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANN EYE CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-10
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty