Provider Demographics
NPI:1811242019
Name:OPTIMAL CARE, LLC
Entity type:Organization
Organization Name:OPTIMAL CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:248-723-9613
Mailing Address - Street 1:24255 W 13 MILE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4322
Mailing Address - Country:US
Mailing Address - Phone:248-723-9613
Mailing Address - Fax:248-723-9615
Practice Address - Street 1:24255 W 13 MILE RD STE 250
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4322
Practice Address - Country:US
Practice Address - Phone:248-723-9613
Practice Address - Fax:248-723-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2024-07-11
Deactivation Date:2022-08-26
Deactivation Code:
Reactivation Date:2022-09-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty