Provider Demographics
NPI:1003807553
Name:REPKO, JAMES M (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:REPKO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 2ND ST
Mailing Address - Street 2:PO BOX 182
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16630-1224
Mailing Address - Country:US
Mailing Address - Phone:814-886-2906
Mailing Address - Fax:814-886-2119
Practice Address - Street 1:505 2ND ST
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-1224
Practice Address - Country:US
Practice Address - Phone:814-886-2906
Practice Address - Fax:814-886-2119
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-G000703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009051220004Medicaid
PAT72765Medicare UPIN
PA425815Medicare ID - Type Unspecified