Provider Demographics
NPI:1972680437
Name:OPTIMUM MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:OPTIMUM MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-591-7714
Mailing Address - Street 1:2000 NW 89TH PL
Mailing Address - Street 2:124
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2618
Mailing Address - Country:US
Mailing Address - Phone:305-591-7714
Mailing Address - Fax:305-591-0189
Practice Address - Street 1:2000 NW 89TH PL
Practice Address - Street 2:124
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2618
Practice Address - Country:US
Practice Address - Phone:305-591-7714
Practice Address - Fax:305-591-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN