Provider Demographics
NPI:1710215090
Name:MANRY OPTOMETRY, INC.
Entity Type:Organization
Organization Name:MANRY OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MANRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:260-375-3573
Mailing Address - Street 1:1431 HALLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:IN
Mailing Address - Zip Code:46792-9257
Mailing Address - Country:US
Mailing Address - Phone:260-375-3573
Mailing Address - Fax:
Practice Address - Street 1:2932 WAL-MART DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750
Practice Address - Country:US
Practice Address - Phone:260-356-9633
Practice Address - Fax:260-356-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002938152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty