Healthcare Provider Details

I. General information

NPI: 1336909092
Provider Name (Legal Business Name): OPTIMIZE COGNITIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 ATRIUM BLVD STE 160
MIDDLETOWN OH
45005-5186
US

IV. Provider business mailing address

42 BUCKMASTER DR
CONCORD MA
01742-2810
US

V. Phone/Fax

Practice location:
  • Phone: 602-206-4018
  • Fax:
Mailing address:
  • Phone: 602-206-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEOFFREY B WALTON
Title or Position: CEO
Credential:
Phone: 602-206-4018