Healthcare Provider Details

I. General information

NPI: 1124250899
Provider Name (Legal Business Name): BOSTON OCULAR PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 MAIN ST
READING MA
01867-3610
US

IV. Provider business mailing address

PO BOX 245
SEARSPORT ME
04974-0245
US

V. Phone/Fax

Practice location:
  • Phone: 800-824-2492
  • Fax: 877-824-2413
Mailing address:
  • Phone: 800-824-2492
  • Fax: 877-824-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code229N00000X
TaxonomyAnaplastologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAYLEE LIZABETH DOUGHERTY
Title or Position: PRESIDENT
Credential: BCO, CCA
Phone: 800-824-2492