Organization
BRUCE L MANNING
Active
Organization
BRUCE L MANNING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE L MANNING (OWNER)
(330) 336-9177
Entity
Organization
Contact information
Practice address
665 BRIARTHORN CRESCENT DR, WADSWORTH, OH 44281-7501
(330) 336-9177
(330) 335-3318
Mailing address
665 BRIARTHORN CRESCENT DR, WADSWORTH, OH 44281-7501
(330) 336-9177
(330) 335-3318
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3551/T547
OH
332H00000X
Eyewear Supplier
T547
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0487567
—
OH
Enumeration date
04/03/2009
Last updated
05/09/2014
Update your record
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