Provider Demographics
NPI:1740568591
Name:OPTIMA SERVICES, PLLC
Entity Type:Organization
Organization Name:OPTIMA SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-986-8010
Mailing Address - Street 1:4330 EAST WEST HIGHWAY
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4408
Mailing Address - Country:US
Mailing Address - Phone:301-986-8010
Mailing Address - Fax:301-986-8011
Practice Address - Street 1:11440 COMMERCE PARK DRIVE
Practice Address - Street 2:LL-4
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1555
Practice Address - Country:US
Practice Address - Phone:703-766-2600
Practice Address - Fax:301-986-8011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFE SEDATION, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-28
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
VA0101230517207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F76954Medicare UPIN