Provider Demographics
NPI:1750387353
Name:SANGEORGE, CHARLES M II (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:SANGEORGE
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4255 MCKINLEY PKWY
Mailing Address - Street 2:INSIDE WAL-MART VISION CENTER
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1005
Mailing Address - Country:US
Mailing Address - Phone:716-646-0564
Mailing Address - Fax:716-646-0571
Practice Address - Street 1:4255 MCKINLEY PKWY
Practice Address - Street 2:INSIDE WAL-MART VISION CENTER
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1005
Practice Address - Country:US
Practice Address - Phone:716-646-0564
Practice Address - Fax:716-646-0571
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYTUV006278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY919920OtherBLOCK VISION
NY000390184002OtherCOMMUNITY BLUE
NYNY3441OtherEYEMED
NY50527OtherDAVIS VISION
NY000390184004OtherCOMMUNITY BLUE
NY17207OtherSPECTERA
NY141345OtherCOLE MANAGED VISION
NY988665OtherHIGHMARK BC & BS
NYNY3441OtherEYEMED
NY919920OtherBLOCK VISION