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General NPI Number Information
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NPI Number | 1235321563
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Entity Type | Organization
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Legal Business Name | JENISE M. MANCINI O.D., P.C.
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 45 DOC STONE RD 101
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City | STAFFORD
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State | VA
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Zip | 22556-4555
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Country | US
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Telephone | 540-720-2020
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Fax | 540-288-2020
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Provider Business Mailing Address
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Address Line | 45 DOC STONE RD 101
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City | STAFFORD
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State | VA
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Zip | 22556-4555
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Country | US
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Telephone | 540-720-2020
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Fax | 540-288-2020
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | AL MANCINI
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Credential |
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Telephone | 703-851-7178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1463
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License Number State | VA
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