Provider Demographics
NPI:1710676515
Name:OPULENT LUX LAB
Entity Type:Organization
Organization Name:OPULENT LUX LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:CRMA PHLEBOTOMIST
Authorized Official - Phone:708-200-8675
Mailing Address - Street 1:1018 E 35TH AVE APT OL
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-1218
Mailing Address - Country:US
Mailing Address - Phone:708-200-8675
Mailing Address - Fax:
Practice Address - Street 1:1018 E 35TH AVE APT OL
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-1218
Practice Address - Country:US
Practice Address - Phone:708-200-8675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory