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General NPI Number Information
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NPI Number | 1689354284
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Entity Type | Organization
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Legal Business Name | OPTIMAL MEDICAL PLLC
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 8906 KINGSTON PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37923-5003
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Country | US
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Telephone | 865-474-7026
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Fax |
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Provider Business Mailing Address
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Address Line | 8906 KINGSTON PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37923-5003
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Country | US
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Telephone | 865-690-4200
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Fax | 865-357-3335
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ASHLEY WILDER
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Credential |
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Telephone | 865-803-3188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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