Southern Ocular Prosthetics, LLC

Primary specialty

OcularistTaxonomy code 156FX1700X

Legal business name

SOUTHERN OCULAR PROSTHETICS, LLC

Practice address

2801 N Decatur Rd Ste 130
Decatur, GA 30033-6049

Phone

(470) 296-2152

NPI assigned

Oct 19, 2022

Last updated

Oct 19, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Antonio Louis Alcorta I, BCO BADONPI 1023500485

Title

President

Phone

(559) 940-1189

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Antonio Louis Alcorta I, BCO

  • Ocularist
  • Visalia, CA
  • NPI 1023500485
  NPD (past) Authorized official

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

{
    "created_epoch": "1666137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666137600000",
    "number": "1417673591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6065 ROSWELL RD STE 870",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303284065",
            "telephone_number": "559-940-1189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 N DECATUR RD STE 130",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300336049",
            "telephone_number": "470-296-2152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OCULAR PROSTHETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-19",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A",
        "authorized_official_last_name": "ALCORTA",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "559-940-1189",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "BCO BADO"
    },
    "taxonomies": [
        {
            "code": "156FX1700X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Ocularist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; 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.