Provider Demographics
NPI:1497866693
Name:CHARLES C MANGER III MD INC
Entity Type:Organization
Organization Name:CHARLES C MANGER III MD INC
Other - Org Name:SADDLEBACK EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-951-4641
Mailing Address - Street 1:23161 MOULTON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LAGUANA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-951-4641
Mailing Address - Fax:949-951-4601
Practice Address - Street 1:23161 MOULTON PARKWAY
Practice Address - Street 2:
Practice Address - City:LAGUANA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-951-4641
Practice Address - Fax:949-951-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG034415207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S551086Medicare ID - Type Unspecified
A45918Medicare UPIN