Provider Demographics
NPI:1457922502
Name:OPTIMUM PROSTHETICS & ORTHOTICS
Entity Type:Organization
Organization Name:OPTIMUM PROSTHETICS & ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPO, LPO, CPO
Authorized Official - Phone:321-446-8781
Mailing Address - Street 1:7345 W SAND LAKE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5280
Mailing Address - Country:US
Mailing Address - Phone:321-446-8781
Mailing Address - Fax:
Practice Address - Street 1:7345 W SAND LAKE RD STE 220
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5280
Practice Address - Country:US
Practice Address - Phone:321-446-8781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier