Basic Information
| Provider Information | |||||||||
| NPI: | 1487022596 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPTIMAL SLEEP SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34120 | ||||||||
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| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895334120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757475050 | ||||||||
| FaxNumber: | 7757475005 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 STEPTOE CIR | ||||||||
| Address2: | |||||||||
| City: | ELY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 893012692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752893611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2015 | ||||||||
| LastUpdateDate: | 09/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | EZENWA | ||||||||
| AuthorizedOfficialFirstName: | INNOCENT | ||||||||
| AuthorizedOfficialMiddleName: | CHUKWUMA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7039099116 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
No ID Information.