Provider Demographics
NPI:1043236938
Name:CHARLES A. GARCIA, M.D.,P.A.
Entity Type:Organization
Organization Name:CHARLES A. GARCIA, M.D.,P.A.
Other - Org Name:CHARLES A. GARCIA, M.D.,P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-332-1559
Mailing Address - Street 1:15 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4123
Mailing Address - Country:US
Mailing Address - Phone:281-332-1559
Mailing Address - Fax:813-323-3942
Practice Address - Street 1:4704 MONTROSE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6122
Practice Address - Country:US
Practice Address - Phone:713-333-0151
Practice Address - Fax:832-485-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207W00000X
TXD6429207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119853303Medicaid
TX0361150001Medicare NSC