Provider Demographics
NPI:1902415359
Name:OPTIMAL DIALYSIS
Entity Type:Organization
Organization Name:OPTIMAL DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUPREE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-777-0224
Mailing Address - Street 1:8315 E 56TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-1078
Mailing Address - Country:US
Mailing Address - Phone:317-777-0224
Mailing Address - Fax:
Practice Address - Street 1:8315 E 56TH ST STE 120
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1078
Practice Address - Country:US
Practice Address - Phone:317-777-0224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment