MEDICARE: ANDREW MANN OPTOMETRIST PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00E01Y	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1124205927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW MANN OPTOMETRIST PA

Provider Business Mailing Address
First Line	:	3607 STONEY OAK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-1936
Country	:	US
Telephone Number	:	281-444-2442
Fax Number	:	281-444-2441

Provider Business Practice Location Address
First Line	:	3607 STONEY OAK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-1936
Country	:	US
Telephone Number	:	281-444-2442
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. SANDY MANN
Credential	:	OD
Telephone Number	:	832-275-4438

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	12/17/2008

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