Healthcare Provider Details

I. General information

NPI: 1174761738
Provider Name (Legal Business Name): OPTIMA HEALTH RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 ROYAL LN SUITE E PMB 225
DALLAS TX
75230-3896
US

IV. Provider business mailing address

5930 ROYAL LN SUITE E PMB 225
DALLAS TX
75230-3896
US

V. Phone/Fax

Practice location:
  • Phone: 214-358-0920
  • Fax: 214-902-9287
Mailing address:
  • Phone: 214-358-0920
  • Fax: 214-902-9287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN BAHLS
Title or Position: DIRECTOR
Credential:
Phone: 214-358-0920