=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366443145
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCU LABS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2005
-----------------------------------------------------
Last Update Date | 12/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7851 METRO PKWY SUITE 225
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55425-1567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-854-6702
-----------------------------------------------------
Fax | 952-854-0761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7851 METRO PKWY SUITE 225
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55425-1567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-854-6702
-----------------------------------------------------
Fax | 952-854-0761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DOUGLAS MATTHEW JOKINEN
-----------------------------------------------------
Credential | OCULARIST
-----------------------------------------------------
Telephone | 952-854-6702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------