Provider Demographics
NPI:1376605816
Name:MICHAEL D. MANGAS, O.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL D. MANGAS, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DRACH
Authorized Official - Last Name:MANGAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-372-7782
Mailing Address - Street 1:2475 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-4476
Mailing Address - Country:US
Mailing Address - Phone:812-372-7782
Mailing Address - Fax:
Practice Address - Street 1:2475 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-4476
Practice Address - Country:US
Practice Address - Phone:812-372-7782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100051800AMedicaid
INT83582Medicare UPIN
IN054300Medicare UPIN