MEDICARE: OPTION 1 NUTRITION SOLUTIONS, CA, 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
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)

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	:	1780868059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTION 1 NUTRITION SOLUTIONS, CA, INC

Provider Business Mailing Address
First Line	:	2460 EAST GERMANN ROAD
Second Line	:	SUITE 18
City	:	CHANDLER
State	:	AZ
Zip	:	85286
Country	:	US
Telephone Number	:	480-883-1188
Fax Number	:	480-883-1193

Provider Business Practice Location Address
First Line	:	3065 RESEARCH DR.
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806
Country	:	US
Telephone Number	:	510-233-7332
Fax Number	:	510-758-9088

Authorized Official
Title or Position	:	CFO
Name	:	MR. ALLEN CHARLESWORTH
Credential	:	CPA
Telephone Number	:	866-883-1188

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	01/14/2015

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Directions to “OPTION 1 NUTRITION SOLUTIONS, CA, INC ” Practice Location

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