MEDICARE: OPTIMA EQUIP 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1366239519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMA EQUIP LLC

Provider Business Mailing Address
First Line	:	4101 MCEWEN RD STE 526
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 MCEWEN RD STE 368
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5112
Country	:	US
Telephone Number	:	469-880-1339
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/MANAGER
Name	:	UNKNOWN FATIMA BEGUM
Credential	:
Telephone Number	:	469-880-1339

Provider Enumeration Date	:	04/22/2025
Last Update Date	:	04/22/2025

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Directions to “OPTIMA EQUIP LLC ” Practice Location

Language	Start Address	Practice Location

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