1821093626 NPI number — DR. CHARLES A GARCIA MD

Table of content: DR. CHARLES A GARCIA MD (NPI 1821093626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821093626 NPI number — DR. CHARLES A GARCIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA
Provider First Name:
CHARLES
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1821093626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12970 EAST FWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77015-5710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-332-1559
Provider Business Mailing Address Fax Number:
281-332-3394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4704 MONTROSE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77006-6122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-333-0151
Provider Business Practice Location Address Fax Number:
832-485-5080
Provider Enumeration Date:
06/17/2005

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: 207WX0107X , with the licence number:  D6429 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: D6429 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 121118 . This is a "COLE VISION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0683377 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1401028-05 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1401028-07 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1401028-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84E730 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 85X310 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: AMERIGROUP . This is a "25344" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8157K0 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 11123 . This is a "COORDINATED VISION CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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