Individual
DR. MARK A MANAHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O. D.
Contact information
Practice address
305 E BROADWAY ST, SAND SPRINGS, OK 74063-7910
(918) 245-2020
(918) 245-2010
Mailing address
305 E BROADWAY ST, SAND SPRINGS, OK 74063-7910
(918) 245-2020
(918) 245-2010
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
962
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007655990A
—
OK
01
—
410020609
RAILROAD MEDICARE
OK
Enumeration date
08/07/2006
Last updated
03/29/2011
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