Healthcare Provider Details

I. General information

NPI: 1760030399
Provider Name (Legal Business Name): OPTIMUM PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 19TH ST
EDMOND OK
73013-6618
US

IV. Provider business mailing address

1501 E 19TH ST
EDMOND OK
73013-6618
US

V. Phone/Fax

Practice location:
  • Phone: 405-471-6511
  • Fax:
Mailing address:
  • Phone: 405-359-5370
  • Fax: 405-359-5481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD SANAULLAH
Title or Position: CEO
Credential: MD
Phone: 405-359-5370