Provider Demographics
NPI:1770740201
Name:OPTIMUM NUTRITION CENTER, INC
Entity type:Organization
Organization Name:OPTIMUM NUTRITION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SECKINGER
Authorized Official - Suffix:SR
Authorized Official - Credentials:CN, ND
Authorized Official - Phone:1800-351-6659
Mailing Address - Street 1:4923 ARMOUR RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5038
Mailing Address - Country:US
Mailing Address - Phone:800-351-6659
Mailing Address - Fax:706-322-1804
Practice Address - Street 1:4923 ARMOUR RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5038
Practice Address - Country:US
Practice Address - Phone:800-351-6659
Practice Address - Fax:706-322-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty