Organization
HOWARD B BOLOS, OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOWARD BOLOS (OWNER)
(321) 636-4422
Entity
Organization
Contact information
Practice address
113 MARYLAND AVE, COCOA, FL 32922-7832
(321) 636-4422
(321) 632-9254
Mailing address
113 MARYLAND AVE, COCOA, FL 32922-7832
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 001719
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078230100
—
FL
Enumeration date
06/01/2012
Last updated
06/01/2012
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