Provider Demographics
NPI:1225031578
Name:MANUEL, RHONDA JO (OD)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:JO
Last Name:MANUEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S MAGNOLIA BLVD
Mailing Address - Street 2:MAGNOLIA VISION CENTER
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355
Mailing Address - Country:US
Mailing Address - Phone:281-259-2020
Mailing Address - Fax:281-259-6866
Practice Address - Street 1:306 MAGNOLIA BLVD
Practice Address - Street 2:MAGNOLIA VISION CENTER
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-8535
Practice Address - Country:US
Practice Address - Phone:281-259-2020
Practice Address - Fax:281-259-6866
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3871TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130997307Medicaid
TXP00110268OtherPALMETTO GBA RAILROAD MEDICARE CARRIER
TX80944QOtherBCBS
TX130997307Medicaid
TXP00110268OtherPALMETTO GBA RAILROAD MEDICARE CARRIER
TX8B8208Medicare PIN