Provider Demographics
NPI:1962514687
Name:OC MEDICAL SUPPLY INCORPORATED
Entity type:Organization
Organization Name:OC MEDICAL SUPPLY INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OJO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CFO
Authorized Official - Phone:714-956-4690
Mailing Address - Street 1:755 N EUCLID STREET
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4116
Mailing Address - Country:US
Mailing Address - Phone:714-956-4690
Mailing Address - Fax:714-956-4692
Practice Address - Street 1:755 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4116
Practice Address - Country:US
Practice Address - Phone:714-956-4690
Practice Address - Fax:714-956-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45849332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5775320001Medicare NSC