Provider Demographics
NPI:1386613453
Name:MANELLO, STEVEN A (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:MANELLO
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 1:3730 WHIPPLE AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718
Mailing Address - Country:US
Mailing Address - Phone:330-493-3937
Mailing Address - Fax:330-493-3110
Practice Address - Street 1:3730 WHIPPLE AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-493-3937
Practice Address - Fax:330-493-3110
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3036/T946152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0347860Medicaid
OH0172240001Medicare NSC
OH0347860Medicaid
OH0435081Medicare PIN