MEDICARE: OPTIMUM MEDICAL SUPPLY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548229610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	2797 S MARYLAND PKWY STE 13
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-1576
Country	:	US
Telephone Number	:	702-796-7772
Fax Number	:	702-796-7773

Provider Business Practice Location Address
First Line	:	2797 S MARYLAND PKWY STE 13
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-1576
Country	:	US
Telephone Number	:	702-796-7772
Fax Number	:	702-796-7773

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PHILIP ADE OJO
Credential	:
Telephone Number	:	702-796-7772

Provider Enumeration Date	:	03/18/2006
Last Update Date	:	03/20/2019

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