Organization
LA FUENTE OCULAR PROSTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON LA FUENTE (MANAGER)
(405) 236-2882
Entity
Organization
Contact information
Practice address
1116 N ROBINSON AVE, OKLAHOMA CITY, OK 73103-4918
(405) 236-2882
(405) 236-3335
Mailing address
1116 N ROBINSON AVE, OKLAHOMA CITY, OK 73103-4918
(405) 236-2882
(405) 236-3335
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100807050A
—
OK
01
—
4631034873-001
BCBS
—
Enumeration date
05/05/2008
Last updated
05/05/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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