Provider Demographics
NPI:1902123052
Name:OPTIMUM LABS INC
Entity Type:Organization
Organization Name:OPTIMUM LABS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:508-993-3710
Mailing Address - Street 1:413 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-5009
Mailing Address - Country:US
Mailing Address - Phone:508-993-3710
Mailing Address - Fax:508-993-3814
Practice Address - Street 1:34 WELBY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-1134
Practice Address - Country:US
Practice Address - Phone:508-993-3710
Practice Address - Fax:508-993-3814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory