MEDICARE: OPTIMUM DIAGNOSTICS 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

General Provider Information

NPI Number	:	1780042077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	7351 WILES RD STE 107
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4106
Country	:	US
Telephone Number	:	561-866-6098
Fax Number	:

Provider Business Practice Location Address
First Line	:	7351 WILES RD STE 107
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4106
Country	:	US
Telephone Number	:	561-866-6098
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRETT SANDMAN
Credential	:
Telephone Number	:	561-866-6098

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	02/02/2016

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Directions to “OPTIMUM DIAGNOSTICS INC ” Practice Location

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