Provider Demographics
NPI:1942961800
Name:OPTIMUM CHOICE LABORATORY
Entity Type:Organization
Organization Name:OPTIMUM CHOICE LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:HILLS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-509-8066
Mailing Address - Street 1:10 RAVENNA LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9681
Mailing Address - Country:US
Mailing Address - Phone:813-509-8066
Mailing Address - Fax:
Practice Address - Street 1:10 RAVENNA LN
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9681
Practice Address - Country:US
Practice Address - Phone:813-509-8066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory