Provider Demographics
NPI:1417097023
Name:OPTIMAL OUTCOMES INC
Entity Type:Organization
Organization Name:OPTIMAL OUTCOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:BETHEL
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:434-799-5786
Mailing Address - Street 1:125 WOODSTOCK WAY
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-5100
Mailing Address - Country:US
Mailing Address - Phone:434-799-5786
Mailing Address - Fax:434-799-0253
Practice Address - Street 1:125 WOODSTOCK WAY
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5100
Practice Address - Country:US
Practice Address - Phone:434-799-5786
Practice Address - Fax:434-799-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA5734333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy