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Organization
BOSTON OCULAR PROSTHETICS INC
Active
Organization
BOSTON OCULAR PROSTHETICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAYLEE LIZABETH DOUGHERTY BCO, CCA (PRESIDENT)
(800) 824-2492
Entity
Organization
Contact information
Practice address
133 MORTLAND RD, SEARSPORT, ME 04974-0245
(207) 352-5001
(877) 824-2413
Mailing address
PO BOX 245, SEARSPORT, ME 04974-0245
(800) 824-2492
(877) 824-2413
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
—
—
229N00000X
Anaplastologist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
NO LICENSE REQUIRED
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005563
ANTHEM INC MAINE
ME
01
—
0597722
AETNA
ME
05
—
122680000
—
ME
05
—
30002787
—
NH
01
—
802828
TUFTS
MA
01
—
M20271
CIGNA
ME
Enumeration date
07/21/2005
Last updated
05/06/2020
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