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General NPI Number Information
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NPI Number | 1376352765
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Entity Type | Organization
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Legal Business Name | OPTIMA MED SPA PLLC
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 03/09/2025
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Provider Practice Location Address
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Address Line | 1950 DODGE RD NE SUITE 106 (INSIDE COLDSTREAM HEALTH)
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402
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Country | US
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Telephone | 319-768-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 WILLIAMS BLVD SW # 2-112
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City | CEDAR RAPIDS
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State | IA
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Zip | 52404-1478
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Country | US
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Telephone | 319-573-2891
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE JOHNSON
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Credential |
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Telephone | 319-768-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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