Provider Demographics
NPI:1750484846
Name:MANNING, KENNETH DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DAVID
Last Name:MANNING
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:PO BOX 5186
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-5186
Mailing Address - Country:US
Mailing Address - Phone:732-671-0050
Mailing Address - Fax:732-671-0056
Practice Address - Street 1:3849 S DELSEA DR
Practice Address - Street 2:C/O SEARS OPTICAL
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7408
Practice Address - Country:US
Practice Address - Phone:732-671-0050
Practice Address - Fax:732-671-0056
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA00377100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521313Medicare ID - Type Unspecified
NJT25901Medicare UPIN