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General NPI Number Information
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NPI Number | 1760030399
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Entity Type | Organization
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Legal Business Name | OPTIMUM PRIMARY CARE PLLC
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 1501 E 19TH ST
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City | EDMOND
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State | OK
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Zip | 73013-6618
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Country | US
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Telephone | 405-471-6511
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 E 19TH ST
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City | EDMOND
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State | OK
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Zip | 73013-6618
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Country | US
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Telephone | 405-359-5370
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Fax | 405-359-5481
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Authorized Official
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Title or Position | CEO
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Name | MUHAMMAD SANAULLAH
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Credential | MD
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Telephone | 405-359-5370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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