Provider Demographics
NPI:1124254529
Name:OPTIMAL IMAGING LLC
Entity type:Organization
Organization Name:OPTIMAL IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:919-228-6366
Mailing Address - Street 1:1000 CENTRE GREEN WAY ,STE 200
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2270
Mailing Address - Country:US
Mailing Address - Phone:919-228-6366
Mailing Address - Fax:919-228-6367
Practice Address - Street 1:1000 CENTRE GREEN WAY STE 200
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2270
Practice Address - Country:US
Practice Address - Phone:919-228-6366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001731230305S00000X
2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty