Provider Demographics
NPI:1366981243
Name:MANHIRE OPTICIANS LLC
Entity type:Organization
Organization Name:MANHIRE OPTICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:908-852-6623
Mailing Address - Street 1:171 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2418
Mailing Address - Country:US
Mailing Address - Phone:908-852-6623
Mailing Address - Fax:908-852-2334
Practice Address - Street 1:171 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2418
Practice Address - Country:US
Practice Address - Phone:908-852-6623
Practice Address - Fax:908-852-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00543000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ39513OtherDAVIS
NJ2908107Medicaid
NJU75739Medicare UPIN
NJ2908107Medicaid