Individual
MR. HENRY LA FUENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCO, BADO
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
156FX1700X
Ocularist
Primary
331034873
OK
224P00000X
Prosthetist
—
—
225000000X
Orthotic Fitter
331034873
OK
229N00000X
Anaplastologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100807050A
—
OK
01
—
1811194368
GROUP NPI
OK
01
—
331034873
TAX ID
OK
Enumeration date
05/27/2006
Last updated
04/02/2012
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