MEDICARE: OPTIMA HEALTH RESOURCES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0060TJ	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1174761738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMA HEALTH RESOURCES LLC

Provider Business Mailing Address
First Line	:	5930 ROYAL LN SUITE E PMB 225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-3896
Country	:	US
Telephone Number	:	214-358-0920
Fax Number	:	214-902-9287

Provider Business Practice Location Address
First Line	:	5930 ROYAL LN SUITE E PMB 225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-3896
Country	:	US
Telephone Number	:	214-358-0920
Fax Number	:	214-902-9287

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SUSAN BAHLS
Credential	:
Telephone Number	:	214-358-0920

Provider Enumeration Date	:	02/04/2009
Last Update Date	:	11/23/2010

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Directions to “OPTIMA HEALTH RESOURCES LLC ” Practice Location

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