MEDICARE: FLORIDA OCULAR PROSTHETICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	R9719	OTHER	BC BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861505612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA OCULAR PROSTHETICS INC

Provider Business Mailing Address
First Line	:	967 SE FEDERAL HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-3702
Country	:	US
Telephone Number	:	772-221-0929
Fax Number	:	772-221-0939

Provider Business Practice Location Address
First Line	:	967 SE FEDERAL HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-3702
Country	:	US
Telephone Number	:	772-221-0929
Fax Number	:	772-221-0939

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. BRENDA HARDWICK JOHNSON
Credential	:
Telephone Number	:	772-221-0929

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	11/23/2015

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Directions to “FLORIDA OCULAR PROSTHETICS INC ” Practice Location

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