Mark A. Mancheski, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2315 Issued in WI

Practice address

1250 E. Mason St.
Green Bay, WI 54301

Phone

(920) 432-3180

Fax

(920) 432-2710

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237248000000",
    "number": "1205929718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 E. MASON ST.",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "920-432-3180",
            "fax_number": "920-432-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 E. MASON ST.",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "920-432-3180",
            "fax_number": "920-432-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCHESKI",
        "first_name": "MARK",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2009-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38587800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyler Allen Malueg
• Christian F Maluf, MD, FACP, FCCP.
• Cynthia A Malvitz-Overly, O.D., F.A.A.O.
• Tasha Joy Malvitz, MA/CCC-SLP
• Mamma Gese
• Trevor James Mancl, DPT
• Michael James Mandich, A.T.C.
• Dimplejit Singh Mangat, DDS
• Erika Susanne Mangin, RN, APN, PMHNP-BC
• Kali Maniam, MD

• Optometrist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.