Provider Demographics
NPI:1578198990
Name:IOM OPI LLC
Entity type:Organization
Organization Name:IOM OPI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DUBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:409-749-0200
Mailing Address - Street 1:PO BOX 20514
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-0514
Mailing Address - Country:US
Mailing Address - Phone:409-924-0004
Mailing Address - Fax:409-347-8083
Practice Address - Street 1:3080 E LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2400
Practice Address - Country:US
Practice Address - Phone:409-749-0200
Practice Address - Fax:409-347-8083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty