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General NPI Number Information
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NPI Number | 1609954965
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Entity Type | Organization
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Legal Business Name | OPTION 1 NUTRITION SOLUTIONS LLC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 3600 OSUNA RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4426
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Country | US
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Telephone | 480-883-1188
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 841042
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City | DALLAS
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State | TX
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Zip | 75284-1042
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Country | US
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Telephone | 480-883-1188
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Fax |
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | JAMES LLOYD WILEY
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Credential |
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Telephone | 480-883-1188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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