MEDICARE: VIKEN A. MANGUIKIAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC3488	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629031794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIKEN A. MANGUIKIAN O.D.

Provider Business Mailing Address
First Line	:	7208 W SAND LAKE RD STE 202
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-5278
Country	:	US
Telephone Number	:	407-271-8931
Fax Number	:	407-674-8712

Provider Business Practice Location Address
First Line	:	7208 W SAND LAKE RD STE 202
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-5278
Country	:	US
Telephone Number	:	407-271-8931
Fax Number	:	407-674-8712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	03/16/2021

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