Provider Demographics
NPI:1225102213
Name:MANSON, BARRY S (OD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:S
Last Name:MANSON
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 1:309 HUNTINGDON PIKE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4447
Mailing Address - Country:US
Mailing Address - Phone:215-663-9700
Mailing Address - Fax:215-663-0363
Practice Address - Street 1:309 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4447
Practice Address - Country:US
Practice Address - Phone:215-663-9700
Practice Address - Fax:215-663-0363
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA580924280OtherMEDICARE RAILROAD
PA00549448Medicaid
PA288108Medicare PIN
PA580924280OtherMEDICARE RAILROAD
PA0669190001Medicare NSC