Provider Demographics
NPI:1629031794
Name:MANGUIKIAN, VIKEN A (OD)
Entity Type:Individual
Prefix:
First Name:VIKEN
Middle Name:A
Last Name:MANGUIKIAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7208 W SAND LAKE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5278
Mailing Address - Country:US
Mailing Address - Phone:407-271-8931
Mailing Address - Fax:407-674-8712
Practice Address - Street 1:7208 W SAND LAKE RD STE 202
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5278
Practice Address - Country:US
Practice Address - Phone:407-271-8931
Practice Address - Fax:407-674-8712
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3488152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621113500Medicaid
FLV09133Medicare UPIN
FL621113500Medicaid
FLU7379ZMedicare PIN
FLU7379VMedicare PIN
FLU7379YMedicare PIN