Provider Demographics
NPI:1508284191
Name:GRABOWSKI OCULAR PROSTHETICS LLC
Entity Type:Organization
Organization Name:GRABOWSKI OCULAR PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GRABOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:BCO BADO
Authorized Official - Phone:559-625-3937
Mailing Address - Street 1:300 E MINERAL KING AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6923
Mailing Address - Country:US
Mailing Address - Phone:559-625-3937
Mailing Address - Fax:559-625-3942
Practice Address - Street 1:300 E MINERAL KING AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6923
Practice Address - Country:US
Practice Address - Phone:559-625-3937
Practice Address - Fax:559-625-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6150480001Medicare UPIN