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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