Healthcare Provider Details

I. General information

NPI: 1578510400
Provider Name (Legal Business Name): THOMAS EARL MANNING O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E TICKLE ST SUITE B
DYERSBURG TN
38024-3163
US

IV. Provider business mailing address

401 E TICKLE ST SUITE B
DYERSBURG TN
38024-3163
US

V. Phone/Fax

Practice location:
  • Phone: 731-285-5411
  • Fax: 731-285-8481
Mailing address:
  • Phone: 731-285-5411
  • Fax: 731-285-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberTN1175
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: