Provider Demographics
NPI:1841066362
Name:OPTIMAL MAN, PLLC
Entity type:Organization
Organization Name:OPTIMAL MAN, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FULKERSIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:910-228-7538
Mailing Address - Street 1:1270 25TH STREET PL SE STE 1
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9657
Mailing Address - Country:US
Mailing Address - Phone:828-220-3190
Mailing Address - Fax:
Practice Address - Street 1:1270 25TH STREET PL SE STE 1
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-9657
Practice Address - Country:US
Practice Address - Phone:828-220-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center