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Individual

JUSTIN LEONARD MANNING

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
9205 N UNION BLVD, SUITE 110, COLORADO SPRINGS, CO 80920-7830
(719) 282-0400
(719) 282-1004
Mailing address
9205 N UNION BLVD, SUITE 110, COLORADO SPRINGS, CO 80920-7830
(719) 282-0400
(719) 282-1004

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
00003278
CO
152W00000X
Optometrist
60378496
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1164863734
WA
Enumeration date
07/11/2013
Last updated
08/02/2018
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