Provider Demographics
NPI:1548482128
Name:OPTIMUS LLC
Entity type:Organization
Organization Name:OPTIMUS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:937-454-1900
Mailing Address - Street 1:8517 NORTH DIXIE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414
Mailing Address - Country:US
Mailing Address - Phone:937-454-1900
Mailing Address - Fax:937-454-1909
Practice Address - Street 1:8517 NORTH DIXIE DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414
Practice Address - Country:US
Practice Address - Phone:937-454-1900
Practice Address - Fax:937-454-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO.11335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2736123Medicaid
OH5902260001Medicare NSC