Provider Demographics
NPI:1609213933
Name:MANGER, CHARLES C III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:C
Last Name:MANGER
Suffix:III
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 1:23161 MOULTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1206
Mailing Address - Country:US
Mailing Address - Phone:949-951-4641
Mailing Address - Fax:949-951-4601
Practice Address - Street 1:23161 MOULTON PKWY
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1206
Practice Address - Country:US
Practice Address - Phone:949-951-4641
Practice Address - Fax:949-951-4601
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG034415207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45918Medicare UPIN