Provider Demographics
NPI:1720216773
Name:KUBLY OCULAR PROSTHETICS INC
Entity Type:Organization
Organization Name:KUBLY OCULAR PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUBLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-977-7676
Mailing Address - Street 1:3500 E FLETCHER AVE
Mailing Address - Street 2:SUITE 509
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4793
Mailing Address - Country:US
Mailing Address - Phone:813-977-7676
Mailing Address - Fax:813-977-1999
Practice Address - Street 1:3500 E FLETCHER AVE
Practice Address - Street 2:SUITE 509
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4793
Practice Address - Country:US
Practice Address - Phone:813-977-7676
Practice Address - Fax:813-977-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6220910001Medicare NSC