Individual
VINCENT MANISCALCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3401 LAKE AVE, FORT WAYNE, IN 46805-5500
(260) 426-3095
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1800439A
IN
Other
Enumeration date
05/30/2023
Last updated
07/07/2023
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