Provider Demographics
NPI:1255388575
Name:MANCO, LOUIS J (OD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:J
Last Name:MANCO
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:671 SECOND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3940
Mailing Address - Country:US
Mailing Address - Phone:215-357-5772
Mailing Address - Fax:215-357-0772
Practice Address - Street 1:671 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3940
Practice Address - Country:US
Practice Address - Phone:215-357-5772
Practice Address - Fax:215-357-0772
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG001336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist