Provider Demographics
NPI:1013530682
Name:ODL ANALYTICAL, LLC
Entity Type:Organization
Organization Name:ODL ANALYTICAL, LLC
Other - Org Name:NA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHAREIF
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:708-238-9913
Mailing Address - Street 1:833 E ARAPAHO RD STE 112
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2245
Mailing Address - Country:US
Mailing Address - Phone:210-251-3204
Mailing Address - Fax:
Practice Address - Street 1:833 E ARAPAHO RD STE 112
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2245
Practice Address - Country:US
Practice Address - Phone:210-251-3204
Practice Address - Fax:210-888-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291U00000XOtherCLINICAL MEDICAL LABORATORY