Provider Demographics
NPI:1023286192
Name:DR. DOUGLAS L. MANN III PC
Entity type:Organization
Organization Name:DR. DOUGLAS L. MANN III PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-351-0040
Mailing Address - Street 1:201 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3115
Mailing Address - Country:US
Mailing Address - Phone:256-351-0040
Mailing Address - Fax:256-301-9449
Practice Address - Street 1:201 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3115
Practice Address - Country:US
Practice Address - Phone:256-351-0040
Practice Address - Fax:256-301-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS918-TA-501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U498711Medicare UPIN
051554583Medicare PIN