Provider Demographics
NPI:1407096076
Name:ANDREW MANN OPTOMETRIST PA
Entity Type:Organization
Organization Name:ANDREW MANN OPTOMETRIST PA
Other - Org Name:VISIONMANN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICIER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-275-4438
Mailing Address - Street 1:3607 STONEY OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-1936
Mailing Address - Country:US
Mailing Address - Phone:832-275-4438
Mailing Address - Fax:
Practice Address - Street 1:2853 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3043
Practice Address - Country:US
Practice Address - Phone:409-924-9994
Practice Address - Fax:409-924-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00513KMedicare PIN