Provider Demographics
NPI:1780952911
Name:OPTIMUM DIAGNOSTICS LLC
Entity type:Organization
Organization Name:OPTIMUM DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MATLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:281-773-4857
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:BARKER
Mailing Address - State:TX
Mailing Address - Zip Code:77413-0112
Mailing Address - Country:US
Mailing Address - Phone:281-773-4857
Mailing Address - Fax:
Practice Address - Street 1:9337 SPRING CYPRESS RD STE E4
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3484
Practice Address - Country:US
Practice Address - Phone:281-773-4857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology