1942429154 NPI number — OCULAR PROSTHETICS LAB INC

Table of content: (NPI 1942429154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942429154 NPI number — OCULAR PROSTHETICS LAB INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCULAR PROSTHETICS LAB INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942429154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 SOUTH BUMBY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32803-4434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-246-5451
Provider Business Mailing Address Fax Number:
407-246-0222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2845 N HARBOR CITY BLVD STE 2-3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32935-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-259-3847
Provider Business Practice Location Address Fax Number:
407-246-0222
Provider Enumeration Date:
04/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOWEN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
321-259-3847

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: M2133 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: NA691 . This is a "WELLCARE INS." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".