Custom Eye Prosthetics Inc

Primary specialty

OcularistTaxonomy code 156FX1700X

License

5001000012 Issued in MI

Legal business name

CUSTOM EYE PROSTHETICS INC

Practice address

27600 Hoover Rd
Warren, MI 48093-7721

Phone

(586) 755-6900

Fax

(586) 755-8026

NPI assigned

Nov 28, 2006

Last updated

Aug 22, 2020By 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

Mr. Terry Allen Bulgarelli Sr., BCO BADO BOARD CERTI

Title

Owner

Phone

(586) 755-6900

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700952975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27600 HOOVER RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480937721",
            "telephone_number": "586-755-6900",
            "fax_number": "586-755-8026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27600 HOOVER RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480937721",
            "telephone_number": "586-755-6900",
            "fax_number": "586-755-8026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM EYE PROSTHETICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BULGARELLI",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-755-6900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "BCO BADO BOARD CERTI"
    },
    "taxonomies": [
        {
            "code": "156FX1700X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Ocularist",
            "state": "MI",
            "license": "5001000012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Technician/Technologist in Warren, MI
• Providers in Warren, MI by specialty
• Technician/Technologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.