Provider Demographics
NPI:1275060931
Name:OPTIMALAB INC
Entity Type:Organization
Organization Name:OPTIMALAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-410-2447
Mailing Address - Street 1:402 W BOUGHTON RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1896
Mailing Address - Country:US
Mailing Address - Phone:630-410-2447
Mailing Address - Fax:630-410-8148
Practice Address - Street 1:402 W BOUGHTON RD
Practice Address - Street 2:SUITE E
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1872
Practice Address - Country:US
Practice Address - Phone:630-410-2447
Practice Address - Fax:630-410-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71114678291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory