Provider Demographics
NPI:1811967557
Name:MANCHESTER FAMILY VISION CENTER PC
Entity type:Organization
Organization Name:MANCHESTER FAMILY VISION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-927-3682
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-0217
Mailing Address - Country:US
Mailing Address - Phone:563-927-3682
Mailing Address - Fax:563-927-6397
Practice Address - Street 1:1214 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-2305
Practice Address - Country:US
Practice Address - Phone:563-927-3682
Practice Address - Fax:563-927-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0796755Medicaid
IA=========OtherUNICARE
IA=========OtherSECURE HORIZONS
IA=========OtherHUMANA
IA=========OtherVSP
IA=========OtherPYRAMID
IA=========OtherADVANTRA
IA=========OtherMEDICARE COMPLETE
IA=========OtherADVANTRA
DO2832Medicare PIN
IA=========OtherUNICARE