Healthcare Provider Details

I. General information

NPI: 1083220933
Provider Name (Legal Business Name): OCULUS INTEREST VI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20115 STUEBNER AIRLINE RD
SPRING TX
77379-5430
US

IV. Provider business mailing address

20115 STUEBNER AIRLINE RD
SPRING TX
77379-5430
US

V. Phone/Fax

Practice location:
  • Phone: 561-275-2020
  • Fax: 561-275-2030
Mailing address:
  • Phone: 561-275-2020
  • Fax: 561-275-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JACKIE BENNET
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 561-612-4531