# HOWARD B BOLOS, OD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013278456
- **Authorized official:** DR. HOWARD BOLOS (OWNER)
- **Authorized official phone:** (321) 636-4422

## Contact information

- **Practice address:** 113 MARYLAND AVE, COCOA, FL 32922-7832
- **Practice address phone:** (321) 636-4422
- **Practice address fax:** (321) 632-9254
- **Mailing address:** 113 MARYLAND AVE, COCOA, FL 32922-7832

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC 001719 | FL | Yes |

## Other

- **Enumeration date:** 06/01/2012
- **Last updated:** 06/01/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 078230100 | — | FL |