Provider Demographics
NPI:1740350057
Name:OPHTHALMIC PROSTHETICS INC
Entity type:Organization
Organization Name:OPHTHALMIC PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCULARIST-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONINO
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-524-5232
Mailing Address - Street 1:5005 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5703
Mailing Address - Country:US
Mailing Address - Phone:713-524-5232
Mailing Address - Fax:713-524-6744
Practice Address - Street 1:5005 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5703
Practice Address - Country:US
Practice Address - Phone:713-524-5232
Practice Address - Fax:713-524-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1104907070OtherNPI-INDIVIDUAL PROVIDER
TX086422501Medicaid
TX0822610001Medicare NSC