Provider Demographics
NPI:1205382017
Name:MANNING, FORREST WALKER (OD)
Entity Type:Individual
Prefix:DR
First Name:FORREST
Middle Name:WALKER
Last Name:MANNING
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:PO BOX 952
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-0952
Mailing Address - Country:US
Mailing Address - Phone:662-455-7840
Mailing Address - Fax:662-455-7841
Practice Address - Street 1:2202 HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930
Practice Address - Country:US
Practice Address - Phone:662-455-7840
Practice Address - Fax:662-455-7841
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS951152W00000X
ALS-D66-TA-A65152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist