Provider Demographics
NPI:1972630168
Name:OPTIMED INFUSION LLC
Entity type:Organization
Organization Name:OPTIMED INFUSION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-430-8022
Mailing Address - Street 1:8080 RAVINES EDGE CT
Mailing Address - Street 2:STE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5424
Mailing Address - Country:US
Mailing Address - Phone:614-430-8022
Mailing Address - Fax:614-430-8025
Practice Address - Street 1:8080 RAVINES EDGE CT
Practice Address - Street 2:STE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-5424
Practice Address - Country:US
Practice Address - Phone:614-430-8022
Practice Address - Fax:614-430-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2370287Medicaid
OH1134199300OtherNPI
OH2370287Medicaid
OHMC0745377Medicare ID - Type UnspecifiedPERSONAL
OH1134199300OtherNPI