Provider Demographics
NPI:1326182544
Name:MANNIKO, EDVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:EDVIN
Middle Name:
Last Name:MANNIKO
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 1:641 E BATES AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-1661
Mailing Address - Country:US
Mailing Address - Phone:303-806-9513
Mailing Address - Fax:303-691-9129
Practice Address - Street 1:9499 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6532
Practice Address - Country:US
Practice Address - Phone:303-427-0998
Practice Address - Fax:303-412-0619
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist