Provider Demographics
NPI:1326622648
Name:OPTIMA HEALTH INSTITUTE INC
Entity Type:Organization
Organization Name:OPTIMA HEALTH INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-420-6646
Mailing Address - Street 1:1456 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4817
Mailing Address - Country:US
Mailing Address - Phone:407-420-7691
Mailing Address - Fax:833-748-0134
Practice Address - Street 1:1456 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4817
Practice Address - Country:US
Practice Address - Phone:407-420-7691
Practice Address - Fax:833-748-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty