MEDICARE: REBECCA JO MANGES OPT

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	156FX1800X	Optician	288010	KY

General Provider Information

NPI Number	:	1285580548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA JO MANGES OPT

Provider Business Mailing Address
First Line	:	110 CONN TERRACE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40508
Country	:	US
Telephone Number	:	859-323-3045
Fax Number	:	859-257-2121

Provider Business Practice Location Address
First Line	:	110 CONN TERRACE
Second Line	:	SUITE 550
City	:	LEXINGTON
State	:	KY
Zip	:	40508
Country	:	US
Telephone Number	:	859-323-3045
Fax Number	:	859-257-2121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	06/12/2026

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Directions to “ REBECCA JO MANGES OPT” Practice Location

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