Provider Demographics
NPI:1811101496
Name:MANN, MICHAEL STEVEN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:MANN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6905 E WEDGEWOOD AVE
Mailing Address - Street 2:6244 W. OAKLAND PARK BLVD
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2901
Mailing Address - Country:US
Mailing Address - Phone:954-746-4009
Mailing Address - Fax:954-747-8025
Practice Address - Street 1:6905 E WEDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-2901
Practice Address - Country:US
Practice Address - Phone:954-592-8970
Practice Address - Fax:954-747-8025
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU40555Medicare UPIN