Provider Demographics
NPI:1184774440
Name:RAYMOND G. MANS, OD PC
Entity type:Organization
Organization Name:RAYMOND G. MANS, OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MANS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-997-3331
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0010
Mailing Address - Country:US
Mailing Address - Phone:541-997-3331
Mailing Address - Fax:541-997-9439
Practice Address - Street 1:535 9TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439
Practice Address - Country:US
Practice Address - Phone:541-997-3331
Practice Address - Fax:541-997-9439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1206ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR00WCYBXBOtherMEDICARE
ORR0000WCYBXOtherMEDICARE
ORR00WCYBXAOtherMEDICARE
OR139325OtherPTAN
OR410027916OtherPALMETTO GBA
ORR00WCYBXCOtherMEDICARE
ORR00WCYBXCOtherMEDICARE
ORR00WCYBXBMedicare PIN
OR139325OtherPTAN
OR410027916OtherPALMETTO GBA
ORT67875Medicare UPIN
ORU50929Medicare UPIN
ORR0000WCYBXMedicare PIN
ORU50930Medicare UPIN