Optimusmed, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

000047 Issued in GA

Legal business name

OPTIMUSMED, LLC

Practice address

1305 Lakes Pkwy
Suite 109
Lawrenceville, GA 30043-5886

Phone

(770) 822-6787

Fax

(800) 454-9615

NPI assigned

Jul 18, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dave Mowry

Title

Ceo

Phone

(760) 795-5440

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Breg, Inc.

  • Prosthetic/Orthotic Supplier
  • Kent, WA
  • NPI 1942675137

  Member Of

  NPD member
• Team Medical, Inc.

  • Prosthetic/Orthotic Supplier
  • Oklahoma City, OK
  • NPI 1316059173

  Member Of

  NPD member

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Team Medical, Inc.

  • Prosthetic/Orthotic Supplier
  • Oklahoma City, OK
  • NPI 1316059173

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741219200000",
    "number": "1124282108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2382 FARADAY AVENUE",
            "address_2": "SUITE 300",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920087220",
            "telephone_number": "760-795-5440",
            "fax_number": "214-501-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 LAKES PKWY",
            "address_2": "SUITE 109",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435886",
            "telephone_number": "770-822-6787",
            "fax_number": "800-454-9615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUSMED, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-18",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A",
        "authorized_official_last_name": "MOWRY",
        "authorized_official_first_name": "DAVE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-795-5440"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "GA",
            "license": "000047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "416145694B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lawrenceville, GA
• Prosthetic/Orthotic Supplier in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.