Provider Demographics
NPI:1558541615
Name:TODD MCMANUS OD ASSOC A LT
Entity Type:Organization
Organization Name:TODD MCMANUS OD ASSOC A LT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMITRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:BRITTON
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-372-6986
Mailing Address - Street 1:302 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2233
Mailing Address - Country:US
Mailing Address - Phone:937-372-6986
Mailing Address - Fax:937-372-5931
Practice Address - Street 1:302 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385
Practice Address - Country:US
Practice Address - Phone:937-372-6986
Practice Address - Fax:937-372-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5225/T2129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2584207Medicaid
OH9355611Medicare PIN
OHU85590Medicare UPIN
OH9373321Medicare PIN
OH4227301Medicare PIN
OH5541370001Medicare NSC