Provider Demographics
NPI:1649393208
Name:MCMANUS, PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:MCMANUS
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 1:950 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-2628
Mailing Address - Country:US
Mailing Address - Phone:603-524-5770
Mailing Address - Fax:603-524-2424
Practice Address - Street 1:950 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2628
Practice Address - Country:US
Practice Address - Phone:603-524-5770
Practice Address - Fax:603-524-2424
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH400152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNA1158OtherHARVARD PILGRIM HEALTH CA
NH80582287NHMedicaid
NH0907701Y0NH02OtherBLUE CROSS
NH0907701Y0NH02OtherBLUE CROSS
NHNA1158OtherHARVARD PILGRIM HEALTH CA