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General NPI Number Information
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NPI Number | 1700498136
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH AND SKIN LLC
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 4701 OLD SHEPARD PL STE 260
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City | PLANO
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State | TX
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Zip | 75093-5250
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Country | US
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Telephone | 972-336-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 5760 LEGACY DR STE B3-355
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City | PLANO
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State | TX
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Zip | 75024-7102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TED GROESBECK
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Credential |
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Telephone | 972-236-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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