Provider Demographics
NPI:1942429154
Name:OCULAR PROSTHETICS LAB INC
Entity type:Organization
Organization Name:OCULAR PROSTHETICS LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:BCO, BADO
Authorized Official - Phone:321-259-3847
Mailing Address - Street 1:10 SOUTH BUMBY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4434
Mailing Address - Country:US
Mailing Address - Phone:407-246-5451
Mailing Address - Fax:407-246-0222
Practice Address - Street 1:2845 N HARBOR CITY BLVD STE 2-3
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6217
Practice Address - Country:US
Practice Address - Phone:321-259-3847
Practice Address - Fax:407-246-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2133OtherBCBS PROVIDER NUMBER
FLNA691OtherWELLCARE INS.
FLM2133OtherBCBS PROVIDER NUMBER
FLNA691OtherWELLCARE INS.
FL0616330003Medicare NSC