Optima Dermatology LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

35074029 Issued in OH

Legal business name

OPTIMA DERMATOLOGY LLC

Practice address

1027 Boardman Canfield Rd
Boardman, OH 44512-4227

Phone

(330) 965-8760

Fax

(330) 965-9325

NPI assigned

Nov 3, 2006

Organization subpart

No

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

Authorized official

Name

Vicki Groner

Title

Billing Manager

Phone

(330) 965-8760

Specialties & licenses 1

Addresses

Other names 1

• Advanced Dermatology and Skin Cancer Center LLC Former legal business name

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1528147352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "987 BOARDMAN CANFIELD RD",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445124222",
            "telephone_number": "330-965-8760",
            "fax_number": "330-965-9325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 BOARDMAN CANFIELD RD",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445124227",
            "telephone_number": "330-965-8760",
            "fax_number": "330-965-9325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMA DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "GRONER",
        "authorized_official_first_name": "VICKI",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "330-965-8760"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OH",
            "license": "35074029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology and Skin Cancer Center LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Michelle Lynn Oliver, R.N.
• Qaadir E Oliver
• Melanie L. Olsen, MSED
• Nicole Kristin Olshanski, CNM
• On Time Rides
• Optima Dermatology LLC
• Jacquelyn Orosz, LPN
• Yarelis Ortiz
• Jessie Ortz
• Kristen Ouellette, CNP

• Clinical Medical Laboratory in Boardman, OH
• Providers in Boardman, OH by specialty
• Clinical Medical Laboratory in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.