MEDICARE: DR. REGINA LOUISE MANES O.D.

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	OPC2192	FL
2	152WP0200X	Pediatric Optometrist	OPC2192	FL
3	152WV0400X	Vision Therapy Optometrist	OPC2192	FL

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	:	1467445312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINA LOUISE MANES O.D.

Provider Business Mailing Address
First Line	:	319 BELVEDERE RD
Second Line	:	STE 1
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-1243
Country	:	US
Telephone Number	:	561-832-0677
Fax Number	:	561-833-1544

Provider Business Practice Location Address
First Line	:	319 BELVEDERE RD
Second Line	:	SUITE 1
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-1252
Country	:	US
Telephone Number	:	561-832-0677
Fax Number	:	561-833-1544

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	11/30/2016

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