Healthcare Provider Details

I. General information

NPI: 1316652696
Provider Name (Legal Business Name): OPTIMA HEALTH PLAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S MAIN ST
HARRISONBURG VA
22801-5819
US

IV. Provider business mailing address

640 S MAIN ST
HARRISONBURG VA
22801-5819
US

V. Phone/Fax

Practice location:
  • Phone: 540-564-5880
  • Fax: 757-440-3285
Mailing address:
  • Phone: 540-564-5880
  • Fax: 757-440-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DORIS PRINCE
Title or Position: DIRECTOR
Credential:
Phone: 175-798-3547