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NPI Code Detail

MEDICARE: LA FUENTE OCULAR PROSTHETICS LLC

MEDICARE: LA FUENTE OCULAR PROSTHETICS LLC
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
1332B00000XDurable Medical Equipment & Medical Supplies
2332BC3200XCustomized Equipment (DME)
3332BD1200XDialysis Equipment & Supplies (DME)
4335E00000XProsthetic/Orthotic Supplier

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21114193604OTHEROKNPI GROUP BCBS
3348742200OTHEROKDOL
4100450270AOTHEROKKMAP
51679520423OTHEROKNPI
6100450270BOTHERKSKMAP

General Provider Information

NPI Number : 1811194368
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA FUENTE OCULAR PROSTHETICS LLC
Provider Business Mailing Address
First Line : 1116 N ROBINSON AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73103-4918
Country : US
Telephone Number : 405-236-2882
Fax Number : 405-236-3335
Provider Business Practice Location Address
First Line : 1116 N ROBINSON AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73103-4918
Country : US
Telephone Number : 405-236-2882
Fax Number : 405-236-3335
Authorized Official
Title or Position : MANAGER
Name : BRANDON RAY LA FUENTE
Credential : OCULARIST
Telephone Number : 405-236-2882
Provider Enumeration Date : 06/28/2007
Last Update Date : 04/02/2012

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Directions to “LA FUENTE OCULAR PROSTHETICS LLC ” Practice Location

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