Provider Demographics
NPI:1578976478
Name:OPTOPIA INC.
Entity Type:Organization
Organization Name:OPTOPIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-562-8571
Mailing Address - Street 1:1304 16TH AVE N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3777
Mailing Address - Country:US
Mailing Address - Phone:904-562-8571
Mailing Address - Fax:904-246-4602
Practice Address - Street 1:1304 16TH AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3777
Practice Address - Country:US
Practice Address - Phone:904-562-8571
Practice Address - Fax:904-246-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5545251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1023045069Medicare NSC