Healthcare Provider Details

I. General information

NPI: 1396466066
Provider Name (Legal Business Name): OPTIMA HEALTH PLAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N MILITARY HWY STE 100
NORFOLK VA
23502-3652
US

IV. Provider business mailing address

PO BOX 746550
ATLANTA GA
30374-6550
US

V. Phone/Fax

Practice location:
  • Phone: 757-233-4500
  • Fax:
Mailing address:
  • Phone: 757-233-4500
  • Fax: 757-252-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry 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: 757-983-5475