Provider Demographics
NPI:1821615873
Name:MANNING, AL'TIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:AL'TIANA
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AL'TIANA
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3076
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72303-3076
Mailing Address - Country:US
Mailing Address - Phone:912-713-6015
Mailing Address - Fax:
Practice Address - Street 1:1979 MARCUS AVENUE SUITE 206
Practice Address - Street 2:
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-243-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005570152W00000X
WI21432-875152W00000X
CT003213152W00000X
NYTUV009456152W00000X
NH1045152W00000X
NJ27OA00708500152W00000X
GAOPT003489152W00000X
TN3609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist