Provider Demographics
NPI:1982627584
Name:MANN, STUART MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:MARK
Last Name:MANN
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Gender:M
Credentials:OD
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Mailing Address - Street 1:1131 W 6TH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-1116
Mailing Address - Country:US
Mailing Address - Phone:909-986-0918
Mailing Address - Fax:909-984-4918
Practice Address - Street 1:795 E. SECOND STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2020
Practice Address - Country:US
Practice Address - Phone:909-706-3794
Practice Address - Fax:909-706-3794
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-09-12
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Provider Licenses
StateLicense IDTaxonomies
CA5737152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10104Medicare UPIN