1750387353 NPI number — DR. CHARLES M SANGEORGE II O.D.

Table of content: DR. CHARLES M SANGEORGE II O.D. (NPI 1750387353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750387353 NPI number — DR. CHARLES M SANGEORGE II O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANGEORGE
Provider First Name:
CHARLES
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750387353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4255 MCKINLEY PKWY
Provider Second Line Business Mailing Address:
INSIDE WAL-MART VISION CENTER
Provider Business Mailing Address City Name:
HAMBURG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14075-1005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-646-0564
Provider Business Mailing Address Fax Number:
716-646-0571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4255 MCKINLEY PKWY
Provider Second Line Business Practice Location Address:
INSIDE WAL-MART VISION CENTER
Provider Business Practice Location Address City Name:
HAMBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14075-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-646-0564
Provider Business Practice Location Address Fax Number:
716-646-0571
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TUV006278 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 919920 . This is a "BLOCK VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000390184002 . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY3441 . This is a "EYEMED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 50527 . This is a "DAVIS VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000390184004 . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 17207 . This is a "SPECTERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 141345 . This is a "COLE MANAGED VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 988665 . This is a "HIGHMARK BC & BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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