Provider Demographics
NPI:1144697764
Name:MANN EYE CENTER, PA
Entity type:Organization
Organization Name:MANN EYE CENTER, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORD
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-275-2457
Mailing Address - Street 1:PO BOX 659506
Mailing Address - Street 2:DEPT 2181
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-9506
Mailing Address - Country:US
Mailing Address - Phone:713-275-2461
Mailing Address - Fax:713-275-2496
Practice Address - Street 1:1601 HIGHWAY 59 LOOP N STE 100
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-6687
Practice Address - Country:US
Practice Address - Phone:936-327-3937
Practice Address - Fax:713-936-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty