Provider Demographics
NPI:1700890803
Name:MALMANGER, DAVID EARL (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EARL
Last Name:MALMANGER
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1575 20TH ST NW STE 101
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-2931
Mailing Address - Country:US
Mailing Address - Phone:507-332-9900
Mailing Address - Fax:507-209-6220
Practice Address - Street 1:1575 20TH ST NW STE 101
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-2931
Practice Address - Country:US
Practice Address - Phone:507-332-9900
Practice Address - Fax:507-209-6220
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN2204152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0277790001Medicare NSC