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General NPI Number Information
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NPI Number | 1578295887
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH PEDIATRICS & FAMILY CARE CLINIC
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 301 BOONE AVE STE A
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City | WINCHESTER
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State | KY
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Zip | 40391-2374
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Country | US
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Telephone | 859-203-6442
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 THATCHERS MILL RD
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City | PARIS
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State | KY
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Zip | 40361-9110
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Country | US
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Telephone | 859-550-0054
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIFFANY JOANN BANKS
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Credential |
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Telephone | 859-550-0054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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