Healthcare Provider Details

I. General information

NPI: 1245064351
Provider Name (Legal Business Name): OPTIMAL PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 MULBERRY LN
MACUNGIE PA
18062-9310
US

IV. Provider business mailing address

51 W END TRL UNIT 189
MACUNGIE PA
18062-5005
US

V. Phone/Fax

Practice location:
  • Phone: 240-492-9277
  • Fax:
Mailing address:
  • Phone: 610-864-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIE TOKHA
Title or Position: MANAGER
Credential:
Phone: 240-492-9277