Provider Demographics
NPI:1821036104
Name:MANN, WILLIAM SCOTT (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SCOTT
Last Name:MANN
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-2416
Mailing Address - Country:US
Mailing Address - Phone:540-639-2020
Mailing Address - Fax:
Practice Address - Street 1:29 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2941
Practice Address - Country:US
Practice Address - Phone:540-381-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA410049825OtherPALMETTO
VA9237208Medicaid
VA461364OtherANTHEM
VA461364OtherANTHEM
VA4715110001Medicare NSC
VA410049825OtherPALMETTO
VA4721480001Medicare NSC
VA00V185E95Medicare PIN
VA9237208Medicaid