Provider Demographics
NPI:1710965629
Name:MCMANIS, DAVID L (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
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 1:4007 E 53RD ST
Mailing Address - Street 2:EYECARE MAX
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3059
Mailing Address - Country:US
Mailing Address - Phone:563-355-4554
Mailing Address - Fax:563-355-4975
Practice Address - Street 1:4007 E 53RD ST
Practice Address - Street 2:EYECARE MAX
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3059
Practice Address - Country:US
Practice Address - Phone:563-355-4554
Practice Address - Fax:563-355-4975
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA1667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA410026190OtherRAILROAD MEDICARE
IA1168617Medicaid
IA1168617Medicaid
IAT01038Medicare UPIN