Provider Demographics
NPI:1215143755
Name:OPTIMUM MEDICAL TESTING
Entity type:Organization
Organization Name:OPTIMUM MEDICAL TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-360-2805
Mailing Address - Street 1:521 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506-4610
Mailing Address - Country:US
Mailing Address - Phone:713-944-1796
Mailing Address - Fax:
Practice Address - Street 1:521 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-4610
Practice Address - Country:US
Practice Address - Phone:713-944-1796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory