Organization
OCULUS INTEREST XII, LLC
Active
Other names
My EyeLab
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE BENNETT (CREDENTIALING MANAGER)
(619) 357-6146
Entity
Organization
Contact information
Practice address
19504 KATY FWY, HOUSTON, TX 77094-1004
(346) 251-0687
(561) 828-8367
Mailing address
20115 STUEBNER AIRLINE RD, SPRING, TX 77379-5430
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
06/19/2020
Last updated
02/19/2021
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