Organization
MARK A. MANAHAN, O.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ARLEN MANAHAN O.D. (OPTOMETRIC PHYSICIAN-OWNER)
(918) 245-2020
Entity
Organization
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
—
100765990A
—
OK
01
—
410020609
RAILROAD MEDICARE
OK
Enumeration date
02/27/2007
Last updated
03/29/2011
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