Provider Demographics
NPI:1689651275
Name:MCMANIS, CRAIG L (OD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:L
Last Name:MCMANIS
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 1:425 SOUTHMORE ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2049
Mailing Address - Country:US
Mailing Address - Phone:765-414-5337
Mailing Address - Fax:
Practice Address - Street 1:901 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1807
Practice Address - Country:US
Practice Address - Phone:317-844-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002231A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000562802OtherBLUE CROSS/BLUE SHIELD
IN000000562802OtherBLUE CROSS/BLUE SHIELD
T69254Medicare UPIN
IN251880AMedicare PIN
INP00603508Medicare PIN