Provider Demographics
NPI:1801915129
Name:MANCHA, ARMANAE AMANDA (OD)
Entity type:Individual
Prefix:DR
First Name:ARMANAE
Middle Name:AMANDA
Last Name:MANCHA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 MAGILL ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79764-1633
Mailing Address - Country:US
Mailing Address - Phone:210-332-3860
Mailing Address - Fax:432-550-4370
Practice Address - Street 1:4702 E UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-8105
Practice Address - Country:US
Practice Address - Phone:432-550-4245
Practice Address - Fax:432-550-4370
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6406TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D3228Medicare ID - Type UnspecifiedINDIVIDUAL MC NUMBER
TXVO4156Medicare UPIN
TX00419YMedicare ID - Type UnspecifiedMC GROUP #