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General NPI Number Information
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NPI Number | 1336324185
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Entity Type | Organization
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Legal Business Name | MANELL & COOPER OPTOMETRIST
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 251 E 4TH AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-4901
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Country | US
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Telephone | 760-745-5412
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Fax | 760-745-2752
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Provider Business Mailing Address
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Address Line | 251 E 4TH AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-4901
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Country | US
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Telephone | 760-745-5412
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Fax | 760-745-2752
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHIRLEY ONEY
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Credential |
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Telephone | 760-745-5412
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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 | 10476
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License Number State | CA
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