Provider Demographics
NPI:1376592188
Name:MANZI, LINCOLN L JR (MD, INC)
Entity Type:Individual
Prefix:DR
First Name:LINCOLN
Middle Name:L
Last Name:MANZI
Suffix:JR
Gender:M
Credentials:MD, INC
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Other - First Name:
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Mailing Address - Street 1:18426 BROOKHURST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6776
Mailing Address - Country:US
Mailing Address - Phone:714-546-2020
Mailing Address - Fax:714-436-2999
Practice Address - Street 1:18426 BROOKHURST ST
Practice Address - Street 2:SUITE # 103
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6776
Practice Address - Country:US
Practice Address - Phone:714-546-2020
Practice Address - Fax:714-436-2929
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG27003207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G270030Medicaid
CAWG27003CMedicare PIN
CAA43175Medicare UPIN
CA0462890001Medicare NSC