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General NPI Number Information
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NPI Number | 1386317733
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Entity Type | Organization
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Legal Business Name | OPTIMUM MEDICAL SUPPLIES LLC
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 1700 N DIXIE HWY STE 114
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City | BOCA RATON
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State | FL
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Zip | 33432-1807
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Country | US
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Telephone | 561-372-9256
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Fax | 561-372-9257
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Provider Business Mailing Address
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Address Line | 1700 N DIXIE HWY STE 114
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City | BOCA RATON
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State | FL
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Zip | 33432-1807
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Country | US
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Telephone | 561-372-9256
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Fax | 561-372-9257
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Authorized Official
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Title or Position | MANAGER
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Name | MICHELLE DEANN BOOHER
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Credential |
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Telephone | 817-298-0950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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