Provider Demographics
NPI:1558430397
Name:MANENTI, ALICIA G (OD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:G
Last Name:MANENTI
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 1:8879 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1932
Mailing Address - Country:US
Mailing Address - Phone:440-526-3160
Mailing Address - Fax:440-526-6869
Practice Address - Street 1:8879 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1932
Practice Address - Country:US
Practice Address - Phone:440-526-3160
Practice Address - Fax:440-526-6869
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0835403Medicare PIN
OHU48381Medicare UPIN
OH0869782Medicare PIN