MEDICARE: DR. ERIC S MANN MD, PHD

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	207W00000X	Ophthalmology Physician	105431	MO
2	207W00000X	Ophthalmology Physician	036-094928	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	213418	OTHER	IL	PTAN
2	06030124	OTHER	IL	BCBSIL
3	3411178005	OTHER	IL	CIGNA
4	431872920	OTHER	IL	COMMERCIAL CARRIERS
5	5234019	OTHER	IL	AETNA
6	5234019	OTHER	MO	AETNA
7	000000012366	OTHER	IL	ESSENCE
8	00827	OTHER	MO	EXCLUSIVE CHOICE MO
9	5234019	OTHER	IL	AETNA IL
10	65960	OTHER	IL	UHC
11	10585	OTHER	IL	GHP
12	143209	OTHER	MO	BCBSMO
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	CB6939	OTHER	MO	RAILROAD MCR MO
15	000000012366	OTHER	MO	ESSENCE MO
16	008257	OTHER	IL	EXCLUSIVE CHOICE
17	000015461	OTHER	MO	PTAN
18	255484	OTHER	IL	HEALTHLINK
19	CB6940	OTHER	IL	RAILROAD MCR IL

General Provider Information

NPI Number	:	1841289014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC S MANN MD, PHD

Provider Business Mailing Address
First Line	:	4550 MEMORIAL DR STE 350
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5372
Country	:	US
Telephone Number	:	618-632-8100
Fax Number	:	618-632-8101

Provider Business Practice Location Address
First Line	:	4550 MEMORIAL DR STE 350
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5372
Country	:	US
Telephone Number	:	618-632-8100
Fax Number	:	618-632-8101

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	11/10/2025

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Directions to “ DR. ERIC S MANN MD, PHD” Practice Location

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