R Alex Mancilla OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

R ALEX MANCILLA OD PC

Practice address

435 W Aten Rd Ste 3
Imperial, CA 92251-9819

Phone

(619) 370-7315

NPI assigned

Sep 18, 2023

Organization subpart

No

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

Authorized official

Name

Raul A Mancilla, ODNPI 1487706198

Title

President/Doctor

Phone

(619) 370-7315

Specialties & licenses 1

Addresses

Other names 1

• Mancilla Family Eyecare Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raul Alex Mancilla, O.D.

  • Optometrist
  • Imperial, CA
  • NPI 1487706198
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706832000000",
    "number": "1750169017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 W ATEN RD STE 3",
            "city": "IMPERIAL",
            "state": "CA",
            "postal_code": "922519819",
            "telephone_number": "619-370-7315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 W ATEN RD STE 3",
            "city": "IMPERIAL",
            "state": "CA",
            "postal_code": "922519819",
            "telephone_number": "619-370-7315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R ALEX MANCILLA OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-18",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A",
        "authorized_official_last_name": "MANCILLA",
        "authorized_official_first_name": "RAUL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/DOCTOR",
        "authorized_official_telephone_number": "619-370-7315",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mancilla Family Eyecare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mancilla Family Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Georgina Paz
• People'S Dental
• Leticia Isabel Peralta, BCBA
• Miroslava Arias Perez
• Alejandro Pineda
• Jaasiel Ramirez Rangel, DDS
• Bianca Ramirez
• Kimberly Ramirez
• Raymond Cervantes Ramos, PHARM.D.
• Benjamin Reisin, MFC

• Optometrist in Imperial, CA
• Providers in Imperial, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.