Provider Demographics
NPI:1467250415
Name:OPTIMAL ROYAL LIVING
Entity type:Organization
Organization Name:OPTIMAL ROYAL LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:IV
Authorized Official - Credentials:LAC
Authorized Official - Phone:813-310-3569
Mailing Address - Street 1:2220 W DORA ST APT 203
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6045
Mailing Address - Country:US
Mailing Address - Phone:813-310-3569
Mailing Address - Fax:
Practice Address - Street 1:2121 S MILL AVE STE 223
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2138
Practice Address - Country:US
Practice Address - Phone:813-310-3569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251E00000XAgenciesHome Health