Provider Demographics
NPI:1659384717
Name:MANN EYE CENTER, PA
Entity Type:Organization
Organization Name:MANN EYE CENTER, PA
Other - Org Name:MANN EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-275-2457
Mailing Address - Street 1:1204 N TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-3540
Mailing Address - Country:US
Mailing Address - Phone:936-336-2100
Mailing Address - Fax:713-275-2466
Practice Address - Street 1:1204 N TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-3540
Practice Address - Country:US
Practice Address - Phone:713-275-2457
Practice Address - Fax:713-275-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2022-05-19
Deactivation Date:2022-03-31
Deactivation Code:
Reactivation Date:2022-05-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00714YMedicare ID - Type Unspecified