Provider Demographics
NPI:1578510400
Name:MANNING, THOMAS EARL (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EARL
Last Name:MANNING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E TICKLE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3163
Mailing Address - Country:US
Mailing Address - Phone:731-285-5411
Mailing Address - Fax:731-285-8481
Practice Address - Street 1:401 E TICKLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3163
Practice Address - Country:US
Practice Address - Phone:731-285-5411
Practice Address - Fax:731-285-8481
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1175152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3722767Medicaid
TN150674OtherBETTER HEALTH
TN3424938OtherCIGNA
TN4065026OtherBLUE CROSS BLUE SHIELD TN
TN4065026OtherTENNCARE SELECT
TN4914090001OtherMEDICARE DMERC
TN4914090001OtherMEDICARE DMERC
TN4065026OtherTENNCARE SELECT
TNP00123495Medicare ID - Type UnspecifiedRAILROAD MEDICARE