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General NPI Number Information
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NPI Number | 1770145138
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Entity Type | Organization
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Legal Business Name | CUSTOM OCULAR PROSTHETICS LLC
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Dates
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Enumeration Date | 07/05/2019
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Last Update Date | 07/05/2019
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Provider Practice Location Address
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Address Line | 10212 5TH AVE NE STE 210
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City | SEATTLE
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State | WA
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Zip | 98125-7471
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Country | US
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Telephone | 206-522-4222
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Fax | 206-525-1496
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Provider Business Mailing Address
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Address Line | 10212 5TH AVE NE STE 210
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City | SEATTLE
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State | WA
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Zip | 98125-7471
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Country | US
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Telephone | 206-522-4222
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Fax | 206-525-1496
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BRIAN E KOCESKI
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Credential |
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Telephone | 206-522-4222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number |
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License Number State |
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