Provider Demographics
NPI:1396991527
Name:MANERA TOTAL VISION CARE, LLC
Entity type:Organization
Organization Name:MANERA TOTAL VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:MANERA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-627-8868
Mailing Address - Street 1:P.O. BOX 3264
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208
Mailing Address - Country:US
Mailing Address - Phone:618-628-8868
Mailing Address - Fax:618-628-3508
Practice Address - Street 1:815 LINCOLN HIGHWAY
Practice Address - Street 2:SUITE #104
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208
Practice Address - Country:US
Practice Address - Phone:618-628-8868
Practice Address - Fax:618-628-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty