Provider Demographics
NPI:1508830597
Name:MANN, JOHN FREDERIC (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERIC
Last Name:MANN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:825 SOUTHMORE AVE STE 821
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-1111
Practice Address - Country:US
Practice Address - Phone:713-473-2020
Practice Address - Fax:713-472-8862
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX3420TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT14578Medicare UPIN