Provider Demographics
NPI:1063536035
Name:OPTIMA PROFESSIONAL SERVICES INC.
Entity type:Organization
Organization Name:OPTIMA PROFESSIONAL SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:CHINYERE
Authorized Official - Last Name:ASONYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-487-0965
Mailing Address - Street 1:1217 WILLOW POINT DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4184
Mailing Address - Country:US
Mailing Address - Phone:972-487-0965
Mailing Address - Fax:972-487-0989
Practice Address - Street 1:1217 WILLOW POINT DR
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4184
Practice Address - Country:US
Practice Address - Phone:972-487-0965
Practice Address - Fax:972-487-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004423251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458486Medicare ID - Type UnspecifiedMEDICARE NUMBER