Provider Demographics
NPI:1326214222
Name:JAMES H. MANASCO, OD PC
Entity type:Organization
Organization Name:JAMES H. MANASCO, OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:MANASCO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-486-4321
Mailing Address - Street 1:1900 11TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-1552
Mailing Address - Country:US
Mailing Address - Phone:205-486-4321
Mailing Address - Fax:205-486-4341
Practice Address - Street 1:1900 11TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-1552
Practice Address - Country:US
Practice Address - Phone:205-486-4321
Practice Address - Fax:205-486-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS344TA053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
406540534OtherMEDICARE RAILROAD
AL000059371Medicaid
51059371OtherBLUE CROSS BLUE SHIELD
AL000059371Medicaid
0123860001Medicare NSC
ALT68973Medicare UPIN