Provider Demographics
NPI:1558429118
Name:MANLY, JANE MACKAY (OD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:MACKAY
Last Name:MANLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3794 COVENTRY CT
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-3358
Mailing Address - Country:US
Mailing Address - Phone:412-973-5367
Mailing Address - Fax:
Practice Address - Street 1:953 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-6146
Practice Address - Country:US
Practice Address - Phone:412-782-6006
Practice Address - Fax:412-782-6006
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-001689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA151628U47, 475150001Medicare PIN