Provider Demographics
NPI:1487179719
Name:OPTIMUM LABWORKS LLC
Entity Type:Organization
Organization Name:OPTIMUM LABWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BAISDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-991-0480
Mailing Address - Street 1:6885 BAUMAN ST
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-8723
Mailing Address - Country:US
Mailing Address - Phone:208-991-0480
Mailing Address - Fax:888-378-3007
Practice Address - Street 1:6885 BAUMAN ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8723
Practice Address - Country:US
Practice Address - Phone:208-991-0480
Practice Address - Fax:888-378-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory