Healthcare Provider Details

I. General information

NPI: 1811967557
Provider Name (Legal Business Name): MANCHESTER FAMILY VISION CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 W MAIN ST
MANCHESTER IA
52057-2305
US

IV. Provider business mailing address

PO BOX 217
MANCHESTER IA
52057-0217
US

V. Phone/Fax

Practice location:
  • Phone: 563-927-3682
  • Fax: 563-927-6397
Mailing address:
  • Phone: 563-927-3682
  • Fax: 563-927-6397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: TERRY L BROWN
Title or Position: PRESIDENT
Credential: OD
Phone: 563-927-3682