Provider Demographics
NPI:1568352714
Name:OPTIMUM PAC PLLC
Entity type:Organization
Organization Name:OPTIMUM PAC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANAULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-367-6180
Mailing Address - Street 1:1501 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6618
Mailing Address - Country:US
Mailing Address - Phone:405-367-6180
Mailing Address - Fax:405-766-5833
Practice Address - Street 1:1501 E 19TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6618
Practice Address - Country:US
Practice Address - Phone:405-367-6180
Practice Address - Fax:405-766-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty