Healthcare Provider Details

I. General information

NPI: 1750500930
Provider Name (Legal Business Name): OCULAR PROSTHETICS LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 W ILLIANA ST
ORLANDO FL
32806-4434
US

IV. Provider business mailing address

10 SOUTH BUMBY AVE
ORLANDO FL
32803-4434
US

V. Phone/Fax

Practice location:
  • Phone: 407-246-5451
  • Fax: 407-246-0222
Mailing address:
  • Phone: 407-246-5451
  • Fax: 407-246-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES RICHARD BOWEN JR.
Title or Position: PRESIDENT
Credential: B.C.O., B.A.D.O.
Phone: 407-246-5451