Provider Demographics
NPI:1164698015
Name:OPTIMA MEDICAL ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:OPTIMA MEDICAL ASSOCIATES, LTD.
Other - Org Name:OPTIMA MEDICAL ASSOCIATES, LTD.
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGONA
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:815-729-0129
Mailing Address - Street 1:1050 ESSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8415
Mailing Address - Country:US
Mailing Address - Phone:815-729-0129
Mailing Address - Fax:815-730-4732
Practice Address - Street 1:1050 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8415
Practice Address - Country:US
Practice Address - Phone:815-729-0129
Practice Address - Fax:815-730-4732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007451261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN