Provider Demographics
NPI:1790979672
Name:MANN, GREGORY V (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:V
Last Name:MANN
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 99
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:NE
Mailing Address - Zip Code:68450-0099
Mailing Address - Country:US
Mailing Address - Phone:402-335-2022
Mailing Address - Fax:402-335-3168
Practice Address - Street 1:131 N 3RD ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:NE
Practice Address - Zip Code:68450-2491
Practice Address - Country:US
Practice Address - Phone:402-335-2022
Practice Address - Fax:402-335-3168
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47069546100Medicaid
NECSO141OtherRR MEDICARE PIN
NE2200006OtherUNITEDHEALTHCARE PIN
NE06766OtherBCBS PIN
NEGUS12D67OtherMUTUAL OF OMAHA PIN
NE0465410002Medicare NSC
NEGUS12D67OtherMUTUAL OF OMAHA PIN
NET77020Medicare UPIN
NE06766OtherBCBS PIN