Provider Demographics
NPI:1720503956
Name:OPTINFUSION SOLUTION, LLC
Entity Type:Organization
Organization Name:OPTINFUSION SOLUTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:FANT
Authorized Official - Last Name:OBMACES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-240-1045
Mailing Address - Street 1:10701 CORPORATE DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477
Mailing Address - Country:US
Mailing Address - Phone:832-500-8169
Mailing Address - Fax:281-819-7152
Practice Address - Street 1:12553 GULF FREEWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034
Practice Address - Country:US
Practice Address - Phone:281-481-8557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty