Healthcare Provider Details

I. General information

NPI: 1366051641
Provider Name (Legal Business Name): OPTIMAL MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10967 ALLISONVILLE RD STE 110B
FISHERS IN
46038-2634
US

IV. Provider business mailing address

10967 ALLISONVILLE RD STE 110B
FISHERS IN
46038-2634
US

V. Phone/Fax

Practice location:
  • Phone: 844-501-1078
  • Fax:
Mailing address:
  • Phone: 844-501-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER FARR
Title or Position: OWNER
Credential: MD
Phone: 844-504-1078