Provider Demographics
NPI:1881747921
Name:GARY S. MANNHEIMER, O.D., PLLC
Entity type:Organization
Organization Name:GARY S. MANNHEIMER, O.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-524-0200
Mailing Address - Street 1:798 SOUTHPARK BLVD
Mailing Address - Street 2:STE. 24
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3615
Mailing Address - Country:US
Mailing Address - Phone:804-524-0200
Mailing Address - Fax:804-524-0400
Practice Address - Street 1:798 SOUTHPARK BLVD
Practice Address - Street 2:STE. 24
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3615
Practice Address - Country:US
Practice Address - Phone:804-524-0200
Practice Address - Fax:804-524-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty