Healthcare Provider Details

I. General information

NPI: 1588505259
Provider Name (Legal Business Name): OPTIMUM SOLE PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SE 25TH LOOP STE 101
OCALA FL
34471-6090
US

IV. Provider business mailing address

1325 SE 25TH LOOP STE 101
OCALA FL
34471-6090
US

V. Phone/Fax

Practice location:
  • Phone: 352-505-4459
  • Fax:
Mailing address:
  • Phone: 352-505-4459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHANNA B WILLIAMS
Title or Position: CEO/OWNER
Credential: DPM
Phone: 248-915-8986