Individual
DR. HOWARD BOLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
113 MARYLAND AVE, COCOA, FL 32922-7832
(321) 636-4422
(321) 632-9254
Mailing address
113 MARYLAND AVE, COCOA, FL 32922-7832
(321) 636-4422
(321) 632-9254
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC1719
FL
152WC0802X
Corneal and Contact Management Optometrist
OPC 001719
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078230100
—
FL
Enumeration date
08/29/2006
Last updated
09/26/2018
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