Healthcare Provider Details

I. General information

NPI: 1417770678
Provider Name (Legal Business Name): OPTIMAL LIVING SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

952 ECHO LN STE 240
HOUSTON TX
77024-2837
US

IV. Provider business mailing address

952 ECHO LN STE 240
HOUSTON TX
77024-2837
US

V. Phone/Fax

Practice location:
  • Phone: 281-733-1300
  • Fax:
Mailing address:
  • Phone: 281-733-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN EDWARD WRIGHT
Title or Position: PRESIDENT
Credential:
Phone: 713-252-0716