Max Steven Mancillas, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1225-3 Issued in KS

Practice address

11548 W 135TH St
Overland Park, KS 66221-2892

Phone

(913) 814-7600

Fax

(913) 814-3906

NPI assigned

May 12, 2006

Last updated

Mar 7, 2023By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Enrolled in KS

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

Specialty

Optometry

Education

University of Houston - College of Optometry, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Four Eyes Optical, LC

  • Optometrist
  • Overland Park, KS
  • NPI 1164681409
  Medicare reassignment NPD Authorized official
• Gerhard W Cibis MD PC

  • Optometrist
  • Kansas City, MO
  • NPI 1376619635
  NPD (past)

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1609827971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10556 BLUEJACKET ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662143029",
            "telephone_number": "913-492-5417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11548 W 135TH ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662212892",
            "telephone_number": "913-814-7600",
            "fax_number": "913-814-3906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCILLAS",
        "first_name": "MAX",
        "middle_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KS",
            "license": "1225-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "1225-3",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "T2655",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cora A Mallot, MD
• Quinton Mallot, PHARM.D
• Madison Malloy, MS, BCBA
• Paul L. Malloy, LSCSW
• Rouba Maluf
• Gina Marie Mandacina, C.P.T.A.
• Gwendolynn Mangers
• Charles Mangine
• Manifest Family Chiropractic
• Marissa Nicole Manker

• Optometrist in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.