MEDICARE: MANCHESTER FAMILY VISION CENTER PC

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

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	:	1811967557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANCHESTER FAMILY VISION CENTER PC

Provider Business Mailing Address
First Line	:	PO BOX 217
Second Line	:
City	:	MANCHESTER
State	:	IA
Zip	:	52057-0217
Country	:	US
Telephone Number	:	563-927-3682
Fax Number	:	563-927-6397

Provider Business Practice Location Address
First Line	:	1214 W MAIN ST
Second Line	:
City	:	MANCHESTER
State	:	IA
Zip	:	52057-2305
Country	:	US
Telephone Number	:	563-927-3682
Fax Number	:	563-927-6397

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERRY L BROWN
Credential	:	OD
Telephone Number	:	563-927-3682

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	10/14/2011

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