Provider Demographics
NPI:1386909471
Name:OPTIMAL ORTHOPEDIC PRODUCTS, LLC
Entity type:Organization
Organization Name:OPTIMAL ORTHOPEDIC PRODUCTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, C.PED, OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DALSEY
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CPED
Authorized Official - Phone:856-809-9910
Mailing Address - Street 1:215 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-2615
Mailing Address - Country:US
Mailing Address - Phone:856-809-9910
Mailing Address - Fax:856-809-9945
Practice Address - Street 1:215 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-2615
Practice Address - Country:US
Practice Address - Phone:856-809-9910
Practice Address - Fax:856-809-9945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRO-FIT PROSTHETIC AND ORTHOTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-05
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies