Organization
KOKOMO OPTICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACKIE LEON ELLIS (PRESIDENT)
(764) 555-1810
Entity
Organization
Contact information
Practice address
501 E LINCOLN RD, KOKOMO, IN 46902-3742
(800) 426-5598
(206) 339-3251
Mailing address
1400 E HILLSBORO BLVD, SUITE 101, DEERFIELD BEACH, FL 33441-4202
(765) 455-1810
(206) 339-3251
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
0002243580
IN
Other
Enumeration date
08/20/2006
Last updated
03/14/2008
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