Provider Demographics
NPI:1184160848
Name:OPTIMUM DME INC
Entity type:Organization
Organization Name:OPTIMUM DME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-352-5800
Mailing Address - Street 1:1101 BRYAN AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4401
Mailing Address - Country:US
Mailing Address - Phone:714-352-5800
Mailing Address - Fax:
Practice Address - Street 1:1101 BRYAN AVE
Practice Address - Street 2:SUITE E
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4401
Practice Address - Country:US
Practice Address - Phone:714-352-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063686616Medicare PIN
CA1891051942Medicare PIN
CA1396857181Medicare PIN
CA1427221134Medicare PIN
CA1871605196Medicare PIN