Healthcare Provider Details

I. General information

NPI: 1881158210
Provider Name (Legal Business Name): INTEGRATED OCULAR PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 W CENTER AVE
VISALIA CA
93291-5804
US

IV. Provider business mailing address

11419 N FOWLER AVE
CLOVIS CA
93619-9544
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-3937
  • Fax: 559-625-3942
Mailing address:
  • Phone: 559-625-3937
  • Fax: 559-625-3942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTONIO L ALCORTA I
Title or Position: OCULARIST, OWNER
Credential: BCO
Phone: 559-625-3937