Provider Demographics
NPI:1629666573
Name:OPTIMUM LAB SERVICES LLC
Entity Type:Organization
Organization Name:OPTIMUM LAB SERVICES LLC
Other - Org Name:CALDWELL TOXICOLOGY LABS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUNDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-842-4075
Mailing Address - Street 1:1361 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-7368
Mailing Address - Country:US
Mailing Address - Phone:610-842-4075
Mailing Address - Fax:
Practice Address - Street 1:6914 S YORKTOWN AVE STE 110
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3933
Practice Address - Country:US
Practice Address - Phone:610-842-4075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory