Organization
OCULAR PROSTHETICS LAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES RICHARD BOWEN JR. B.C.O, B.A.D.O. (OFFICE ADMINISTRATOR)
(321) 259-3847
Entity
Organization
Contact information
Practice address
2845 N HARBOR CITY BLVD STE 2-3, MELBOURNE, FL 32935-6217
(321) 259-3847
(407) 246-0222
Mailing address
10 SOUTH BUMBY AVE, ORLANDO, FL 32803-4434
(407) 246-5451
(407) 246-0222
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M2133
BCBS PROVIDER NUMBER
FL
01
—
NA691
WELLCARE INS.
FL
Enumeration date
04/25/2007
Last updated
06/28/2021
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