Provider Demographics
NPI:1023426756
Name:UNIVERSE OPTIMAX INC
Entity type:Organization
Organization Name:UNIVERSE OPTIMAX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-414-5001
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-0162
Mailing Address - Country:US
Mailing Address - Phone:847-414-5001
Mailing Address - Fax:
Practice Address - Street 1:5632 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3100
Practice Address - Country:US
Practice Address - Phone:847-414-5001
Practice Address - Fax:877-578-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies