Provider Demographics
NPI:1346754660
Name:ROBERT MANAHAN, LLC
Entity Type:Organization
Organization Name:ROBERT MANAHAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-934-9033
Mailing Address - Street 1:535 FORTUNE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3428
Mailing Address - Country:US
Mailing Address - Phone:402-934-9033
Mailing Address - Fax:402-934-9506
Practice Address - Street 1:535 FORTUNE DR STE 200
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3428
Practice Address - Country:US
Practice Address - Phone:402-934-9033
Practice Address - Fax:402-934-9506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty