Provider Demographics
NPI:1578372314
Name:OPTIMIZE NUTRITION LLC
Entity type:Organization
Organization Name:OPTIMIZE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDURA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:773-234-1431
Mailing Address - Street 1:2305 N AVERS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2203
Mailing Address - Country:US
Mailing Address - Phone:773-234-1431
Mailing Address - Fax:
Practice Address - Street 1:2305 N AVERS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2203
Practice Address - Country:US
Practice Address - Phone:773-234-1431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty