Provider Demographics
NPI:1447627641
Name:OPTIM ORTHOPEDICS, LLC
Entity type:Organization
Organization Name:OPTIM ORTHOPEDICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-644-1626
Mailing Address - Street 1:210 E DERENNE AVE
Mailing Address - Street 2:ATTN.: PROVIDER ENROLLMENT
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6736
Mailing Address - Country:US
Mailing Address - Phone:912-644-1626
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:3345 US HIGHWAY 84
Practice Address - Street 2:SUITE 100
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-2159
Practice Address - Country:US
Practice Address - Phone:912-629-6942
Practice Address - Fax:912-644-5280
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIM ORTHOPEDICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty