Provider Demographics
NPI:1316284847
Name:MANERA, ALEX (OD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:MANERA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 LINCOLN HWY
Mailing Address - Street 2:SUITE #104
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2230
Mailing Address - Country:US
Mailing Address - Phone:618-628-8868
Mailing Address - Fax:618-628-3508
Practice Address - Street 1:815 LINCOLN HWY
Practice Address - Street 2:SUITE #104
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2230
Practice Address - Country:US
Practice Address - Phone:618-628-8868
Practice Address - Fax:618-628-3508
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU-41370Medicare UPIN