Provider Demographics
NPI:1417921073
Name:MANN, PAUL C (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:MANN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3725 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3410
Mailing Address - Country:US
Mailing Address - Phone:515-255-5533
Mailing Address - Fax:515-255-8002
Practice Address - Street 1:3725 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3410
Practice Address - Country:US
Practice Address - Phone:515-255-5533
Practice Address - Fax:515-255-8002
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0047365Medicaid
IA42115239727OtherJOHN DEERE HEALTH
IA28186OtherBLUE CROSS BLUE SHIELD
IA72076OtherCOVENTRY
IA0047365Medicaid
IA28186OtherBLUE CROSS BLUE SHIELD