Provider Demographics
NPI:1568563906
Name:MANNING, COLETTE (OD)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:COLETTE
Other - Middle Name:
Other - Last Name:MATHIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6404 MCCART AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-4701
Mailing Address - Country:US
Mailing Address - Phone:817-294-7456
Mailing Address - Fax:817-294-5443
Practice Address - Street 1:6404 MCCART AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-4701
Practice Address - Country:US
Practice Address - Phone:817-294-7456
Practice Address - Fax:682-708-7345
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4511TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y489Medicare PIN