Provider Demographics
NPI:1407091101
Name:OPTIONS LAB, INC.
Entity Type:Organization
Organization Name:OPTIONS LAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-882-1646
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-0179
Mailing Address - Country:US
Mailing Address - Phone:920-882-1646
Mailing Address - Fax:920-882-1647
Practice Address - Street 1:4000 W SPENCER ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-4015
Practice Address - Country:US
Practice Address - Phone:920-882-1646
Practice Address - Fax:920-882-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100016778Medicaid