MEDICARE: DR. GREGORY V MANN 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	921	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CSO141	OTHER	NE	RR MEDICARE PIN

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
3	2200006	OTHER	NE	UNITEDHEALTHCARE PIN
4	06766	OTHER	NE	BCBS PIN
5	GUS12D67	OTHER	NE	MUTUAL OF OMAHA PIN

General Provider Information

NPI Number	:	1790979672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY V MANN O.D.

Provider Business Mailing Address
First Line	:	PO BOX 99
Second Line	:
City	:	TECUMSEH
State	:	NE
Zip	:	68450-0099
Country	:	US
Telephone Number	:	402-335-2022
Fax Number	:	402-335-3168

Provider Business Practice Location Address
First Line	:	131 N 3RD ST
Second Line	:
City	:	TECUMSEH
State	:	NE
Zip	:	68450-2491
Country	:	US
Telephone Number	:	402-335-2022
Fax Number	:	402-335-3168

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

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	05/22/2008

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Directions to “ DR. GREGORY V MANN O.D.” Practice Location

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