Provider Demographics
NPI:1841289014
Name:MANN, ERIC S (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:MANN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503856
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:618-632-8100
Mailing Address - Fax:618-632-8101
Practice Address - Street 1:4550 MEMORIAL DR STE 350
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5372
Practice Address - Country:US
Practice Address - Phone:618-632-8100
Practice Address - Fax:618-632-8101
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105431207W00000X
IL036-094928207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213418OtherPTAN
IL06030124OtherBCBSIL
IL3411178005OtherCIGNA
IL431872920OtherCOMMERCIAL CARRIERS
IL5234019OtherAETNA
MO5234019OtherAETNA
IL000000012366OtherESSENCE
MO00827OtherEXCLUSIVE CHOICE MO
IL5234019OtherAETNA IL
IL65960OtherUHC
IL10585OtherGHP
MO143209OtherBCBSMO
MO207652041Medicaid
MOCB6939OtherRAILROAD MCR MO
MO000000012366OtherESSENCE MO
IL008257OtherEXCLUSIVE CHOICE
MO000015461OtherPTAN
IL255484OtherHEALTHLINK
ILCB6940OtherRAILROAD MCR IL
F80854Medicare UPIN
IL5234019OtherAETNA IL