Provider Demographics
NPI:1134144991
Name:OPTISON MOBILE ULTRASOUND
Entity Type:Organization
Organization Name:OPTISON MOBILE ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CLEMENT
Authorized Official - Last Name:ENDRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-950-1161
Mailing Address - Street 1:174 ARGONNE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3232
Mailing Address - Country:US
Mailing Address - Phone:562-439-7866
Mailing Address - Fax:877-428-1296
Practice Address - Street 1:174 ARGONNE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3232
Practice Address - Country:US
Practice Address - Phone:562-439-7866
Practice Address - Fax:877-428-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116772471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty