Provider Demographics
NPI:1821437179
Name:ORTHOPEDIC CENTER PC
Entity Type:Organization
Organization Name:ORTHOPEDIC CENTER PC
Other - Org Name:OPTIM HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY PROGRAM ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-644-5300
Mailing Address - Street 1:4683 CHABOT DRIVE # 200
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588
Mailing Address - Country:US
Mailing Address - Phone:925-621-2902
Mailing Address - Fax:925-269-8423
Practice Address - Street 1:210 E DERENNE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6736
Practice Address - Country:US
Practice Address - Phone:912-644-5300
Practice Address - Fax:912-644-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043962174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty