Healthcare Provider Details

I. General information

NPI: 1184160848
Provider Name (Legal Business Name): OPTIMUM DME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BRYAN AVE SUITE E
TUSTIN CA
92780-4401
US

IV. Provider business mailing address

1101 BRYAN AVE SUITE E
TUSTIN CA
92780-4401
US

V. Phone/Fax

Practice location:
  • Phone: 714-352-5800
  • Fax:
Mailing address:
  • Phone: 714-352-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ALVIN CHANG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-352-5800