Active NPI
Laurel Gillette Mannen, O.D.
- Optometrist
- Saint Helens, OR
National Provider Identifier
1467553693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1442 ATI
- Practice address
- 1864 Columbia Blvd
Saint Helens, OR 97051-1733 - Phone
- (503) 396-0928
- Fax
- (503) 397-7701
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1442 ATI | OR | Primary |
Addresses
Primary practice location
1864 Columbia Blvd
Saint Helens, OR 97051-1733
Mailing address
1864 Columbia Blvd
Saint Helens, OR 97051-1733
Phone (503) 396-0928
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 127902 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1442 ATI | OR | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Vision of Oregon PC | Optometrist | Past | Accepting new patients |
| Family Vision of Oregon PC | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Saint Helens, OR
- NPI 1952515918
-
- Optometrist
- Scappoose, OR
- NPI 1992903454
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195084800000",
"number": "1467553693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1864 COLUMBIA BLVD",
"city": "SAINT HELENS",
"state": "OR",
"postal_code": "970511733",
"telephone_number": "503-396-0928",
"fax_number": "503-397-7701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1864 COLUMBIA BLVD",
"city": "SAINT HELENS",
"state": "OR",
"postal_code": "970511733",
"telephone_number": "503-396-0928",
"fax_number": "503-397-7701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANNEN",
"first_name": "LAUREL",
"middle_name": "GILLETTE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-26",
"last_updated": "2007-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OR",
"license": "1442 ATI",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "127902",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Helens, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.