Provider Demographics
NPI:1639885627
Name:OCEANVIEW ORTHOTIC SUPPLIES LLC
Entity Type:Organization
Organization Name:OCEANVIEW ORTHOTIC SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAIRO
Authorized Official - Last Name:GOMEZ MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-516-0877
Mailing Address - Street 1:6011 RODMAN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33023-1854
Mailing Address - Country:US
Mailing Address - Phone:954-516-0877
Mailing Address - Fax:954-516-0887
Practice Address - Street 1:6011 RODMAN ST STE 111
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33023-1854
Practice Address - Country:US
Practice Address - Phone:954-516-0877
Practice Address - Fax:954-516-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies