Healthcare Provider Details

I. General information

NPI: 1306297650
Provider Name (Legal Business Name): OCULUS HEALTH MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 JIM REDMAN PKWY
PLANT CITY FL
33566-9460
US

IV. Provider business mailing address

1808 JIM REDMAN PKWY #117
PLANT CITY FL
33563-6914
US

V. Phone/Fax

Practice location:
  • Phone: 863-608-5330
  • Fax: 813-754-4432
Mailing address:
  • Phone: 813-752-5838
  • Fax: 813-754-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC1905
License Number StateFL

VIII. Authorized Official

Name: DR. ROY BRUCE
Title or Position: OPTOMETRIST
Credential: OD
Phone: 863-608-5330