Provider Demographics
NPI:1821093626
Name:GARCIA, CHARLES A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4123
Mailing Address - Country:US
Mailing Address - Phone:281-332-1559
Mailing Address - Fax:281-332-3394
Practice Address - Street 1:4704 MONTROSE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6122
Practice Address - Country:US
Practice Address - Phone:713-333-0151
Practice Address - Fax:832-485-5080
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6429207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85X310OtherBCBS
TX121118OtherCOLE VISION
TX1401028-03Medicaid
TX11123OtherCOORDINATED VISION CARE
TX1401028-05Medicaid
TX84E730OtherBCBS
TX0683377OtherAETNA
TXAMERIGROUPOther25344
TX1401028-07Medicaid
TX8157K0OtherBCBS
TX1401028-07Medicaid
TX1401028-07Medicaid
TX84E730OtherBCBS
TX8147K0Medicare ID - Type Unspecified