Provider Demographics
NPI:1750338836
Name:OMNEURON INC
Entity type:Organization
Organization Name:OMNEURON INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DECHARMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-327-1121
Mailing Address - Street 1:99 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-5232
Mailing Address - Country:US
Mailing Address - Phone:650-327-1121
Mailing Address - Fax:650-327-1122
Practice Address - Street 1:99 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-5232
Practice Address - Country:US
Practice Address - Phone:650-327-1121
Practice Address - Fax:650-327-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31857ZMedicare ID - Type Unspecified