Provider Demographics
NPI:1306297650
Name:OCULUS HEALTH MANAGEMENT
Entity type:Organization
Organization Name:OCULUS HEALTH MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:863-608-5330
Mailing Address - Street 1:1808 JIM REDMAN PKWY
Mailing Address - Street 2:#117
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-6914
Mailing Address - Country:US
Mailing Address - Phone:813-752-5838
Mailing Address - Fax:813-754-4432
Practice Address - Street 1:2602 JIM REDMAN PKWY
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-9460
Practice Address - Country:US
Practice Address - Phone:863-608-5330
Practice Address - Fax:813-754-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078599700Medicaid
FLT93931Medicare UPIN
FL078599700Medicaid