MEDICARE: JEFFREY A MANN OPTICIAN

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	1546	MA

General Provider Information

NPI Number	:	1366551061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY A MANN OPTICIAN

Provider Business Mailing Address
First Line	:	33 LINCOLN STREET
Second Line	:
City	:	NEWTON HIGHLANDS
State	:	MA
Zip	:	02461
Country	:	US
Telephone Number	:	617-332-2664
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 LINCOLN ST
Second Line	:
City	:	NEWTON HIGHLANDS
State	:	MA
Zip	:	02461-1526
Country	:	US
Telephone Number	:	617-332-2664
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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