Provider Demographics
NPI:1912052192
Name:OPTIMAL READINGS PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:OPTIMAL READINGS PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:615-986-6099
Mailing Address - Street 1:75 REMITTANCE DR DEPT 6621
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6621
Mailing Address - Country:US
Mailing Address - Phone:615-986-6099
Mailing Address - Fax:205-815-6690
Practice Address - Street 1:1900 TEBEAU ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6357
Practice Address - Country:US
Practice Address - Phone:912-283-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510G700034Medicare PIN
CADE737AMedicare PIN
GAGRP595Medicare PIN
GAGRP8046Medicare PIN