Provider Demographics
NPI:1457755118
Name:OPTIMAL RADIOLOGY PARTNERS OF VIRGINIA, PLLC
Entity Type:Organization
Organization Name:OPTIMAL RADIOLOGY PARTNERS OF VIRGINIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-429-0957
Mailing Address - Street 1:75 REMITTANCE DRIVE
Mailing Address - Street 2:STE 6507
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6507
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:
Practice Address - Street 1:75 SKYLYN DRIVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307
Practice Address - Country:US
Practice Address - Phone:864-573-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty