Provider Demographics
NPI:1508264375
Name:MANN EYE CENTER, PA
Entity Type:Organization
Organization Name:MANN EYE CENTER, PA
Other - Org Name:MANN EYE 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-275-2457
Mailing Address - Street 1:PO BOX 4615
Mailing Address - Street 2:MSC 275
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210
Mailing Address - Country:US
Mailing Address - Phone:713-275-2461
Mailing Address - Fax:713-275-2496
Practice Address - Street 1:9745 FM 1960 BYPASS RD W
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4069
Practice Address - Country:US
Practice Address - Phone:832-412-1233
Practice Address - Fax:831-412-4657
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANN EYE CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-10
Last Update Date:2022-05-19
Deactivation Date:2022-03-31
Deactivation Code:
Reactivation Date:2022-05-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty