MEDICARE: JEFFREY A 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	156FX1800X	Optician	MA 1546	MA

General Provider Information

NPI Number	:	1376721977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY A MANN

Provider Business Mailing 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	:	617-332-1218

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	:	617-332-1218

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEFFREY A MANN
Credential	:	DISPENSING OPTICIAN
Telephone Number	:	617-332-2664

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	03/17/2008

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