Provider Demographics
NPI:1124652243
Name:OCULUS INTERESTS V, LLC
Entity type:Organization
Organization Name:OCULUS INTERESTS V, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-433-6009
Mailing Address - Street 1:20530 INTERSTATE 45 N STE 2710
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-2900
Mailing Address - Country:US
Mailing Address - Phone:346-380-2020
Mailing Address - Fax:561-828-8367
Practice Address - Street 1:20530 NORTH FWY STE A
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-2903
Practice Address - Country:US
Practice Address - Phone:346-380-2020
Practice Address - Fax:561-828-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty