Active NPI
Mark Replogle
- Optometrist
- Corona, CA
National Provider Identifier
1184205395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 35319
- Practice address
- 482 N Main St Ste 101
Corona, CA 92878-3452 - Phone
- (951) 493-2150
- NPI assigned
- Apr 19, 2021
- Last updated
- Oct 25, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Optometrist | 152W00000X | 35319 | CA | Primary |
Addresses
Primary practice location
482 N Main St Ste 101
Corona, CA 92878-3452
Mailing address
19660 Carmelita Ave
Corona, CA 92881-4304
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230224002102 | CA | Order and Referring Only - Optometry | 6800269689 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698192000000",
"number": "1184205395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19660 CARMELITA AVE",
"city": "CORONA",
"state": "CA",
"postal_code": "928814304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "482 N MAIN ST STE 101",
"city": "CORONA",
"state": "CA",
"postal_code": "928783452",
"telephone_number": "951-493-2150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REPLOGLE",
"first_name": "MARK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-19",
"last_updated": "2023-10-25",
"certification_date": "2023-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "35319",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.