LA FUENTE OCULAR PROSTHETICS LLC
Dialysis Equipment and Supplies
Oklahoma City, Oklahoma
Provider NPI: 1811194368
Organization Information:Organization Name: LA FUENTE OCULAR PROSTHETICS LLC
Practice Location:
1116 N ROBINSON AVE OKLAHOMA CITY, OK 73103 US
Tel: 405-236-2882 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
1116 N ROBINSON AVE OKLAHOMA CITY, OK 73103 US
Tel: 405-236-2882 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 332B00000X | Suppliers Durable Medical Equipment & Medical Supplies | ||
N | 332BC3200X | Suppliers Durable Medical Equipment & Medical Supplies | ||
N | 332BD1200X | Suppliers Durable Medical Equipment & Medical Supplies | ||
Y | 335E00000X | Suppliers Prosthetic/Orthotic Supplier |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
NPI GROUP BCBS | 1114193604 | OK | 01 |
100807050A | OK | 05 | |
DOL | 348742200 | OK | 01 |
KMAP | 100450270A | OK | 01 |
NPI | 1679520423 | OK | 01 |
KMAP | 100450270B | KS | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin