Provider Demographics
NPI:1407953508
Name:MANION, MICHAEL KENT (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KENT
Last Name:MANION
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 1:4457 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1379
Mailing Address - Country:US
Mailing Address - Phone:937-306-1640
Mailing Address - Fax:937-306-1573
Practice Address - Street 1:4457 WALNUT ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-1379
Practice Address - Country:US
Practice Address - Phone:937-306-1640
Practice Address - Fax:937-306-1573
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1747152W00000X
OH5689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist