Healthcare Provider Details

I. General information

NPI: 1114804200
Provider Name (Legal Business Name): VANESSA MANLOVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 52ND AVE S STE 130
FARGO ND
58104-5565
US

IV. Provider business mailing address

2932 5TH ST W UNIT K
WEST FARGO ND
58078-8143
US

V. Phone/Fax

Practice location:
  • Phone: 701-929-9028
  • Fax:
Mailing address:
  • Phone: 701-212-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VANESSA MANLOVE
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 701-212-8603