MEDICARE: HARRIS MANN

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	002845	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376504548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRIS MANN

Provider Business Mailing Address
First Line	:	40 CROSSHILL RD
Second Line	:
City	:	HARTSDALE
State	:	NY
Zip	:	10530-3013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 E FORDHAM RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5014
Country	:	US
Telephone Number	:	718-562-5000
Fax Number	:

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	05/01/2008

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Directions to “ HARRIS MANN ” Practice Location

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