Provider Demographics
NPI:1417533993
Name:OPTIMAL ORTHOPEDIC CARE S C
Entity Type:Organization
Organization Name:OPTIMAL ORTHOPEDIC CARE S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-226-0688
Mailing Address - Street 1:7186 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9736
Mailing Address - Country:US
Mailing Address - Phone:262-226-0688
Mailing Address - Fax:
Practice Address - Street 1:7186 S 76TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9736
Practice Address - Country:US
Practice Address - Phone:262-226-0688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty