Organization
MEDICAL DEPARTMENT STORE AND DISCOUNT UNIFORMS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN OCASIO (PRESIDENT)
(239) 274-0304
Entity
Organization
Contact information
Practice address
8595 COLLEGE PKWY, FORT MYERS, FL 33919-5191
(239) 482-6111
(239) 482-6178
Mailing address
PO BOX 07100, FORT MYERS, FL 33919-0100
(239) 274-0304
(239) 274-0307
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
800017
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R9258
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/20/2006
Last updated
08/22/2020
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