Active NPI
Efrain Mascareno, O.D.
- Optometrist
- Chula Vista, CA
National Provider Identifier
1457507279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 10906
- Practice address
- 440 4TH Ave
Chula Vista, CA 91910-4443 - Phone
- (619) 427-2020
- NPI assigned
- Aug 12, 2008
- Last updated
- Apr 17, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 10906 | CA | Primary |
Addresses
Primary practice location
440 4TH Ave
Chula Vista, CA 91910-4443
Mailing address
440 4TH Ave
Chula Vista, CA 91910-4443
Phone (619) 427-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0109061 | Medicaid | CA |
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
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- University of California - School of Optometry, 1997
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
440 4TH Ave
Chula Vista, CA 91910-4443
Phone (619) 427-2020
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366156800000",
"number": "1457507279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "440 4TH AVE",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919104443",
"telephone_number": "619-427-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 4TH AVE",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919104443",
"telephone_number": "619-427-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASCARENO",
"first_name": "EFRAIN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-12",
"last_updated": "2013-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "10906",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0109061",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; 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.