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General NPI Number Information
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NPI Number | 1417770678
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Entity Type | Organization
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Legal Business Name | OPTIMAL LIVING SERVICE, INC.
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 952 ECHO LN STE 240
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City | HOUSTON
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State | TX
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Zip | 77024-2837
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Country | US
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Telephone | 281-733-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 952 ECHO LN STE 240
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City | HOUSTON
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State | TX
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Zip | 77024-2837
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Country | US
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Telephone | 281-733-1300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN EDWARD WRIGHT
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Credential |
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Telephone | 713-252-0716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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