Provider Demographics
NPI:1295746204
Name:MANHIRE, DOUGLAS R (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:R
Last Name:MANHIRE
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07880-0308
Mailing Address - Country:US
Mailing Address - Phone:908-852-6623
Mailing Address - Fax:
Practice Address - Street 1:171 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2418
Practice Address - Country:US
Practice Address - Phone:908-852-6623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD-775156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ39513OtherDAVIS VISION
NJ2908107Medicaid
NJ39513OtherDAVIS VISION