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General NPI Number Information
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NPI Number | 1750484846
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Entity Type | Individual
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Provider Name | KENNETH DAVID MANNING O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 3849 S DELSEA DR C/O SEARS OPTICAL
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City | VINELAND
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State | NJ
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Zip | 08360-7408
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Country | US
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Telephone | 732-671-0050
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Fax | 732-671-0056
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Provider Business Mailing Address
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Address Line | PO BOX 5186
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City | TOMS RIVER
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State | NJ
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Zip | 08754-5186
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Country | US
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Telephone | 732-671-0050
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Fax | 732-671-0056
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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 | OA00377100
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License Number State | NJ
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