Provider Demographics
NPI:1619943370
Name:ZAMBRANO, MANUEL RAMON JR (OD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:RAMON
Last Name:ZAMBRANO
Suffix:JR
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 1:10559 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-1860
Mailing Address - Country:US
Mailing Address - Phone:504-739-1244
Mailing Address - Fax:
Practice Address - Street 1:6000 US-98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-1006
Practice Address - Country:US
Practice Address - Phone:850-505-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12504 TPA152WC0802X
AZ1439152WC0802X
NV781152WC0802X
TX10795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10795OtherOPTOMETRY LICENSE
NV781OtherNV STATE BOARD OF OPTOMETRY
CA12504TOtherOPTOMETRY LICENSE
AZ1439OtherOPTOMETRY LICENSE
AZ477032Medicaid
TX1619943370Medicaid