Healthcare Provider Details

I. General information

NPI: 1689290157
Provider Name (Legal Business Name): OCULUS INTERESTS XI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10407 NORTH FWY STE E
HOUSTON TX
77037-1136
US

IV. Provider business mailing address

20115 STUEBNER AIRLINE RD
SPRING TX
77379-5430
US

V. Phone/Fax

Practice location:
  • Phone: 346-803-2509
  • Fax: 561-828-8367
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JACKIE BENNETT
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 561-612-4531