Provider Demographics
NPI:1639468515
Name:CHARLES P BOGIE III MD PHD INC PC
Entity Type:Organization
Organization Name:CHARLES P BOGIE III MD PHD INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BOGIE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:405-945-4747
Mailing Address - Street 1:3435 NW 56TH ST
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4448
Mailing Address - Country:US
Mailing Address - Phone:405-945-4747
Mailing Address - Fax:405-945-4748
Practice Address - Street 1:3435 NW 56TH ST
Practice Address - Street 2:SUITE 1010
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4448
Practice Address - Country:US
Practice Address - Phone:405-945-4747
Practice Address - Fax:405-945-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20772207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty