Provider Demographics
NPI:1215070412
Name:MANN, VICTOR (OD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:MANN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 BROWN DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1767
Mailing Address - Country:US
Mailing Address - Phone:619-469-4694
Mailing Address - Fax:619-469-6411
Practice Address - Street 1:2542 BROWN DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1767
Practice Address - Country:US
Practice Address - Phone:619-469-4694
Practice Address - Fax:619-469-6411
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3801T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3801TMedicare UPIN