Provider Demographics
NPI:1881158210
Name:INTEGRATED OCULAR PROSTHETICS
Entity type:Organization
Organization Name:INTEGRATED OCULAR PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCULARIST, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALCORTA
Authorized Official - Suffix:I
Authorized Official - Credentials:BCO
Authorized Official - Phone:559-625-3937
Mailing Address - Street 1:11419 N FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9544
Mailing Address - Country:US
Mailing Address - Phone:559-625-3937
Mailing Address - Fax:559-625-3942
Practice Address - Street 1:1324 W CENTER AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5804
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:2019-01-30
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty