Provider Demographics
NPI:1659529055
Name:MANGAL, WALID (DO)
Entity Type:Individual
Prefix:MR
First Name:WALID
Middle Name:
Last Name:MANGAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1050 SE MONTEREY ROAD, SUITE #104
Mailing Address - Street 2:FLORIDA VISION INSTITUTE INC.
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-283-2020
Mailing Address - Fax:772-219-7924
Practice Address - Street 1:1050 SE MONTEREY ROAD, SUITE #104
Practice Address - Street 2:FLORIDA VISION INSTITUTE INC.
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-283-2020
Practice Address - Fax:772-219-7924
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS12479207W00000X, 207WX0107X
MDH0074109207W00000X
VA0102203133207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0552984 01Medicaid
VA1659529055Medicaid
MD243079ZACKMedicare PIN
VA1659529055Medicaid