Organization
CUSTOM OCULAR PROSTHETICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTONIO LOUIS ALCORTA I BCO (OWNER)
(559) 940-1189
Entity
Organization
Contact information
Practice address
401 S MAIN ST, SUITE B6, ALPHARETTA, GA 30009-1974
(770) 667-1166
(770) 667-1188
Mailing address
401 S MAIN ST, SUITE B6, ALPHARETTA, GA 30009-1974
(770) 667-1166
(770) 667-1188
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00062048A
—
GA
Enumeration date
12/13/2007
Last updated
01/08/2025
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