Howard B Bolos, OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 001719 Issued in FL

Legal business name

HOWARD B BOLOS, OD PA

Practice address

113 Maryland Ave
Cocoa, FL 32922-7832

Phone

(321) 636-4422

Fax

(321) 632-9254

NPI assigned

Jun 1, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Howard Bolos

Title

Owner

Phone

(321) 636-4422

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338508800000",
    "number": "1013278456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 MARYLAND AVE",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329227832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 MARYLAND AVE",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329227832",
            "telephone_number": "321-636-4422",
            "fax_number": "321-632-9254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOWARD B BOLOS, OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-01",
        "last_updated": "2012-06-01",
        "status": "A",
        "authorized_official_last_name": "BOLOS",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-636-4422",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 001719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078230100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Cocoa, FL
• Providers in Cocoa, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.