Provider Demographics
NPI:1114804200
Name:VANESSA MANLOVE PLLC
Entity type:Organization
Organization Name:VANESSA MANLOVE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-212-8603
Mailing Address - Street 1:2932 5TH ST W UNIT K
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8143
Mailing Address - Country:US
Mailing Address - Phone:701-212-8603
Mailing Address - Fax:
Practice Address - Street 1:4541 52ND AVE S STE 103
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5565
Practice Address - Country:US
Practice Address - Phone:701-929-9028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty