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General NPI Number Information
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NPI Number | 1043452154
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Entity Type | Organization
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Legal Business Name | BRUCE L MANNING
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Dates
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Enumeration Date | 04/03/2009
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 665 BRIARTHORN CRESCENT DR
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City | WADSWORTH
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State | OH
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Zip | 44281-7501
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Country | US
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Telephone | 330-336-9177
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Fax | 330-335-3318
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Provider Business Mailing Address
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Address Line | 665 BRIARTHORN CRESCENT DR
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City | WADSWORTH
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State | OH
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Zip | 44281-7501
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Country | US
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Telephone | 330-336-9177
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Fax | 330-335-3318
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE L MANNING
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Credential |
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Telephone | 330-336-9177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | T547
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3551/T547
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License Number State | OH
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