Healthcare Provider Details

I. General information

NPI: 1699428714
Provider Name (Legal Business Name): OPTIHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2022
Last Update Date: 01/29/2022
Certification Date: 01/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 S 9500 E
HUNTSVILLE UT
84317-9766
US

IV. Provider business mailing address

2650 WASHINGTON BLVD STE 103
OGDEN UT
84401-3623
US

V. Phone/Fax

Practice location:
  • Phone: 801-628-5735
  • Fax:
Mailing address:
  • Phone: 385-333-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CASTILLO
Title or Position: MANAGER
Credential: APRN
Phone: 801-556-4864