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Individual

RICHARD B MANGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
1935 BLUEGRASS AVE, SUITE 200, LOUISVILLE, KY 40215-1179
(502) 364-0033
(502) 361-4488
Mailing address
1935 BLUEGRASS AVE, SUITE 200, LOUISVILLE, KY 40215-1179
(502) 364-0033
(502) 361-4488

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1403DT
KY
152W00000X
Optometrist
18003024A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200313540
IN
05
2246224
OH
05
77014033
KY
Enumeration date
12/27/2005
Last updated
12/22/2014
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