Provider Demographics
NPI:1306812979
Name:EIFRIG, CHARLES WILLIAM GUSTAV (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM GUSTAV
Last Name:EIFRIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23521 PASEO DE VALENCIA
Mailing Address - Street 2:SUITE 207 (TAJ MAJAL BUILDING)
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3107
Mailing Address - Country:US
Mailing Address - Phone:949-707-5125
Mailing Address - Fax:
Practice Address - Street 1:23521 PASEO DE VALENCIA
Practice Address - Street 2:SUITE 207 (TAJ MAJAL BUILDING)
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3107
Practice Address - Country:US
Practice Address - Phone:949-707-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300335207W00000X
CAC53104207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB4007OtherRAILROAD MEDICARE GROUP
P00102182OtherRR MEDICARE INDIVIDUAL ID
562043271OtherOPTICARE GROUP ID
134EFOtherBCBS INDIVIDUAL ID
2090301OtherUNITED HEALTHCARE INDIVID
562043271OtherMAMSI GROUP ID
562043271OtherUNITED HEALTHCARE GROUP
C7150OtherMEDCOST INDIVIDUAL ID
26600OtherOPTICARE INDIVIDUAL ID
562043271OtherMEDCOST GROUP ID
NC89134EFMedicaid
2115757OtherMAMSI INDIVIDUAL ID
3201207OtherAETNA HMO INDIVIDUAL ID
7674444OtherAETNA PPO INDIVIDUAL ID
014T8OtherBCBS GROUP ID
NC89014T8Medicaid
562043271OtherAETNA HMO/PPO GROUP ID
NCH44557Medicare UPIN
134EFOtherBCBS INDIVIDUAL ID
2333843Medicare ID - Type UnspecifiedMEDICARE GROUP ID