Provider Demographics
NPI:1194850743
Name:RAYMOND G. MANS, OD PC
Entity Type:Organization
Organization Name:RAYMOND G. MANS, OD PC
Other - Org Name:FLORENCE REEDSPORT EYE CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MANS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-271-2312
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467-0065
Mailing Address - Country:US
Mailing Address - Phone:541-271-2312
Mailing Address - Fax:541-271-4502
Practice Address - Street 1:108 N 7TH ST
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1503
Practice Address - Country:US
Practice Address - Phone:541-271-2312
Practice Address - Fax:541-271-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1206ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT67875Medicare UPIN
ORU50930Medicare UPIN