Provider Demographics
NPI:1699474320
Name:OPTIVRX, LLC
Entity type:Organization
Organization Name:OPTIVRX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:865-206-1550
Mailing Address - Street 1:1002 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-4530
Mailing Address - Country:US
Mailing Address - Phone:865-206-1550
Mailing Address - Fax:865-500-3968
Practice Address - Street 1:1600 BREDA DR FL B
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1405
Practice Address - Country:US
Practice Address - Phone:865-500-4987
Practice Address - Fax:865-500-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ082117Medicaid
TN0000007565OtherBOARD OF PHARMACY LICENSE