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Organization

LA FUENTE OCULAR PROSTHETICS LLC

Active
Other names
La Fuente Prosthetics
Organization subpart
No

Provider details

NPI number
Authorized official
BRANDON RAY LA FUENTE OCULARIST (MANAGER)
(405) 236-2882
Entity
Organization

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
332B00000X
Durable Medical Equipment & Medical Supplies
332BC3200X
Customized Equipment (DME)
332BD1200X
Dialysis Equipment & Supplies (DME)
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
100450270A
KMAP
OK
01
100450270B
KMAP
KS
05
100807050A
OK
01
1114193604
NPI GROUP BCBS
OK
01
1679520423
NPI
OK
01
348742200
DOL
OK
Enumeration date
06/28/2007
Last updated
04/02/2012
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