Provider Demographics
NPI:1376510388
Name:MANN, ALICE M (OD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:M
Last Name:MANN
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:2453 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4710
Mailing Address - Country:US
Mailing Address - Phone:516-746-3836
Mailing Address - Fax:516-746-3837
Practice Address - Street 1:22104 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2333
Practice Address - Country:US
Practice Address - Phone:718-225-7400
Practice Address - Fax:718-225-7606
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYVUT004899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22184GMedicare PIN
NYT81543Medicare UPIN