Provider Demographics
NPI:1104914183
Name:MCMANMAN, CAROL ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ELIZABETH
Last Name:MCMANMAN
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:7632 JAMES AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-2426
Mailing Address - Country:US
Mailing Address - Phone:763-561-1452
Mailing Address - Fax:763-780-7632
Practice Address - Street 1:8450 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-1164
Practice Address - Country:US
Practice Address - Phone:763-780-9553
Practice Address - Fax:763-780-9632
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN2203152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNUO9774Medicare UPIN