Healthcare Provider Details

I. General information

NPI: 1326154766
Provider Name (Legal Business Name): JENNA MARIE MANNING OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 SOUTH DOWNING ST SUITE 100
DENVER CO
80210
US

IV. Provider business mailing address

2480 SOUTH DOWNING ST SUITE 100
DENVER CO
80210
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-5455
  • Fax: 303-777-1175
Mailing address:
  • Phone: 303-777-5455
  • Fax: 303-777-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2079
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: