Organization
SOUTHERN OCULAR PROSTHETICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO LOUIS ALCORTA I BCO BADO (PRESIDENT)
(559) 940-1189
Entity
Organization
Contact information
Practice address
2801 N DECATUR RD STE 130, DECATUR, GA 30033-6049
(470) 296-2152
Mailing address
6065 ROSWELL RD STE 870, SANDY SPRINGS, GA 30328-4065
(559) 940-1189
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
—
—
Other
Enumeration date
10/19/2022
Last updated
10/19/2022
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