Basic Information
| Provider Information | |||||||||
| NPI: | 1689651275 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMANIS | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 S 2ND ST | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450112802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134541462 | ||||||||
| FaxNumber: | 5134541462 | ||||||||
| Practice Location | |||||||||
| Address1: | 3526 OSBORNE LANE | ||||||||
| Address2: | SUITE F | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479093998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654772000 | ||||||||
| FaxNumber: | 7654772002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18002231A | IN | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 000000562802 | 01 | IN | BLUE CROSS/BLUE SHIELD | OTHER |