Provider Demographics
NPI:1972519783
Name:MANNING, DAVID JUSTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JUSTIN
Last Name:MANNING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1122 MAIN ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-9524
Mailing Address - Country:US
Mailing Address - Phone:501-796-8040
Mailing Address - Fax:501-796-3773
Practice Address - Street 1:1122 MAIN ST
Practice Address - Street 2:SUITE 12
Practice Address - City:VILONIA
Practice Address - State:AR
Practice Address - Zip Code:72173-9524
Practice Address - Country:US
Practice Address - Phone:501-796-8040
Practice Address - Fax:501-796-3773
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist