Provider Demographics
NPI:1639141534
Name:MANASCO, JAMES HUNTER (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HUNTER
Last Name:MANASCO
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 1:1900 11TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-1552
Mailing Address - Country:US
Mailing Address - Phone:205-486-4321
Mailing Address - Fax:205-486-4341
Practice Address - Street 1:1900 11TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-1552
Practice Address - Country:US
Practice Address - Phone:205-486-4321
Practice Address - Fax:205-486-4341
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS344TA053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-59371OtherBLUE CROSS BLUE SHIELD
AL924418OtherBLOCK VISION
AL406540534OtherMEDICARE TRAVELERS
AL000059371Medicaid
AL630870003OtherFEDERAL TAX ID NUMBER
AL406540534OtherMEDICARE TRAVELERS
AL000059371Medicare ID - Type Unspecified
AL000059371Medicaid