MEDICARE: MANN EYE CENTER, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770050254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANN EYE CENTER, PA

Provider Business Mailing Address
First Line	:	PO BOX 659506
Second Line	:	DEPT 2181
City	:	SAN ANTONIO
State	:	TX
Zip	:	78265-9506
Country	:	US
Telephone Number	:	713-275-2461
Fax Number	:	713-275-2496

Provider Business Practice Location Address
First Line	:	6624 FANNIN ST STE 2105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2333
Country	:	US
Telephone Number	:	713-791-9494
Fax Number	:	713-795-0524

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	JILL ROSALES
Credential	:
Telephone Number	:	713-275-2457

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	03/31/2022

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Directions to “MANN EYE CENTER, PA ” Practice Location

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