Healthcare Provider Details

I. General information

NPI: 1861505612
Provider Name (Legal Business Name): FLORIDA OCULAR PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 SE FEDERAL HWY
STUART FL
34994-3702
US

IV. Provider business mailing address

967 SE FEDERAL HWY
STUART FL
34994-3702
US

V. Phone/Fax

Practice location:
  • Phone: 772-221-0929
  • Fax: 772-221-0939
Mailing address:
  • Phone: 772-221-0929
  • Fax: 772-221-0939

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: MRS. BRENDA HARDWICK JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 772-221-0929