Provider Demographics
NPI:1740949387
Name:OPTIMUS LABS LLC
Entity type:Organization
Organization Name:OPTIMUS LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-434-0960
Mailing Address - Street 1:570 MEMORIAL CIR STE 110
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5063
Mailing Address - Country:US
Mailing Address - Phone:360-434-0960
Mailing Address - Fax:386-287-5776
Practice Address - Street 1:570 MEMORIAL CIR STE 110
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5063
Practice Address - Country:US
Practice Address - Phone:360-434-0960
Practice Address - Fax:386-287-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty