Provider Demographics
NPI:1750500930
Name:OCULAR PROSTHETICS LAB INC
Entity type:Organization
Organization Name:OCULAR PROSTHETICS LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:BCO, BADO
Authorized Official - Phone:407-246-5451
Mailing Address - Street 1:10 SOUTH BUMBY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4434
Mailing Address - Country:US
Mailing Address - Phone:407-246-5451
Mailing Address - Fax:407-246-0222
Practice Address - Street 1:36 W ILLIANA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4434
Practice Address - Country:US
Practice Address - Phone:407-246-5451
Practice Address - Fax:407-246-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNA691OtherWELLCARE
FLM2133OtherBCBS FL
FLM2133OtherBCBS FL
FL=========OtherCOMMERCIAL INS.
FL=========OtherPED-I-CARE
FLNA691OtherWELLCARE
FL=========OtherHEALTH CHOICE