Provider Demographics
NPI:1588645253
Name:BOGIE, CHARLES P III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:BOGIE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5622 N PORTLAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2000
Mailing Address - Country:US
Mailing Address - Phone:405-418-4800
Mailing Address - Fax:405-418-4820
Practice Address - Street 1:5622 N PORTLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-528-8193
Practice Address - Fax:405-528-0626
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2018-05-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK20772207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100228220CMedicaid
H39817Medicare UPIN
180043729Medicare PIN
OK100228220CMedicaid