Provider Demographics
NPI:1073687851
Name:EFRAIN MASCARENO OD APC
Entity Type:Organization
Organization Name:EFRAIN MASCARENO OD APC
Other - Org Name:CLEAR VISION OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASCARENO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-427-2020
Mailing Address - Street 1:440 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4443
Mailing Address - Country:US
Mailing Address - Phone:619-427-2020
Mailing Address - Fax:866-254-5707
Practice Address - Street 1:440 4TH AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4443
Practice Address - Country:US
Practice Address - Phone:619-427-2020
Practice Address - Fax:866-254-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10906T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0109061Medicaid
CASD0109061Medicaid
CAW19388Medicare ID - Type Unspecified