Active NPI
Mark A Manahan, O. D.
- Optometrist
- Sand Springs, OK
National Provider Identifier
1528077500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 962
- Practice address
- 305 E Broadway St
Sand Springs, OK 74063-7910 - Phone
- (918) 245-2020
- Fax
- (918) 245-2010
- NPI assigned
- Aug 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 962 | OK | Primary |
Addresses
Primary practice location
305 E Broadway St
Sand Springs, OK 74063-7910
Mailing address
305 E Broadway St
Sand Springs, OK 74063-7910
Phone (918) 245-2020
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007655990A | Medicaid | OK | |
| 410020609 | Other | OK | RAILROAD MEDICARE |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301356800000",
"number": "1528077500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 E BROADWAY ST",
"city": "SAND SPRINGS",
"state": "OK",
"postal_code": "740637910",
"telephone_number": "918-245-2020",
"fax_number": "918-245-2010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 E BROADWAY ST",
"city": "SAND SPRINGS",
"state": "OK",
"postal_code": "740637910",
"telephone_number": "918-245-2020",
"fax_number": "918-245-2010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANAHAN",
"first_name": "MARK",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O. D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-07",
"last_updated": "2011-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OK",
"license": "962",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007655990A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410020609",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sand Springs, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.