Active NPI
Mark A Manary, O.D.
- Optometrist
- Jefferson City, MO
National Provider Identifier
1972594224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TO3364
- Practice address
- 2421 W Edgewood Dr
Ste a
Jefferson City, MO 65109-5844 - Phone
- (573) 636-2103
- NPI assigned
- Nov 3, 2005
- 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 | TO3364 | MO | Primary |
Addresses
Primary practice location
2421 W Edgewood Dr
Ste a
Jefferson City, MO 65109-5844
Mailing address
2421 W Edgewood Dr
Ste a
Jefferson City, MO 65109-5844
Phone (573) 636-2103
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 318903804 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2023 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TO3364 | MO | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359504000000",
"number": "1972594224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2421 W EDGEWOOD DR",
"address_2": "STE A",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651095844",
"telephone_number": "573-636-2103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2421 W EDGEWOOD DR",
"address_2": "STE A",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651095844",
"telephone_number": "573-636-2103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANARY",
"first_name": "MARK",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-03",
"last_updated": "2013-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "TO3364",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "318903804",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.