Provider Demographics
NPI:1578064002
Name:OPTIMUMEDICINE LLC
Entity Type:Organization
Organization Name:OPTIMUMEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:K
Authorized Official - Last Name:EISMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-286-6490
Mailing Address - Street 1:5010 S DECATUR BLVD STE G&H
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4934
Mailing Address - Country:US
Mailing Address - Phone:844-922-8669
Mailing Address - Fax:702-302-4569
Practice Address - Street 1:5010 S DECATUR BLVD STE G&H
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4934
Practice Address - Country:US
Practice Address - Phone:844-922-8669
Practice Address - Fax:702-302-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416A0800X
NV3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No3416A0800XTransportation ServicesAmbulanceAir Transport