1114129350 NPI number — MANN EYE CENTER, PA

Table of content: (NPI 1114129350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114129350 NPI number — MANN EYE CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANN EYE CENTER, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114129350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18850 S. MEMORIAL BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-275-2457
Provider Business Mailing Address Fax Number:
713-275-2466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18850 S MEMORIAL DR
Provider Second Line Business Practice Location Address:
ALL LOCATIONS
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-4288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-275-2456
Provider Business Practice Location Address Fax Number:
713-936-2789
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSALES
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
713-275-2457

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0059KD . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 158554902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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