MEDICARE: CHARLES P BOGIE III MD PHD INC PC

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	20772	OK

General Provider Information

NPI Number	:	1881992824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES P BOGIE III MD PHD INC PC

Provider Business Mailing Address
First Line	:	9400 MORNING VIEW RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-6616
Country	:	US
Telephone Number	:	405-819-1886
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 MORNING VIEW RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-6616
Country	:	US
Telephone Number	:	405-819-1886
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES PAUL BOGIE
Credential	:	MD PHD
Telephone Number	:	405-819-1886

Provider Enumeration Date	:	02/28/2011
Last Update Date	:	02/28/2011

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