Provider Demographics
NPI:1255588877
Name:MANZELLA, CHRISTINE ANN (OD, MPH)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANN
Last Name:MANZELLA
Suffix:
Gender:F
Credentials:OD, MPH
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:MANZELLA-CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD, MPH
Mailing Address - Street 1:1580 MASSACHUSETTS AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-4212
Mailing Address - Country:US
Mailing Address - Phone:941-545-6132
Mailing Address - Fax:954-656-1049
Practice Address - Street 1:3520 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1310
Practice Address - Country:US
Practice Address - Phone:727-369-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4344152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist