Provider Demographics
NPI:1750317244
Name:MANIO, SERAPHIM C (OD)
Entity Type:Individual
Prefix:
First Name:SERAPHIM
Middle Name:C
Last Name:MANIO
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 1:860 E CARSON ST STE 107
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-7941
Mailing Address - Country:US
Mailing Address - Phone:310-549-2020
Mailing Address - Fax:310-549-2797
Practice Address - Street 1:860 E CARSON ST STE 107
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-7941
Practice Address - Country:US
Practice Address - Phone:310-549-2020
Practice Address - Fax:310-549-2797
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9713T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330739641OtherCOMPBENEFITS
CASD0097130Medicaid
CA330739641OtherCOMPBENEFITS
CAU57541Medicare UPIN