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General NPI Number Information
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NPI Number | 1376510388
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Entity Type | Individual
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Provider Name | ALICE M MANN O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 22104 HORACE HARDING EXPY
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-2333
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Country | US
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Telephone | 718-225-7400
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Fax | 718-225-7606
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Provider Business Mailing Address
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Address Line | 2453 JERICHO TPKE
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City | GARDEN CITY PARK
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State | NY
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Zip | 11040-4710
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Country | US
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Telephone | 516-746-3836
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Fax | 516-746-3837
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | VUT004899
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License Number State | NY
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