MEDICARE: OPTIMUM HEALTH TELEHEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1255045548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM HEALTH TELEHEALTH SERVICES

Provider Business Mailing Address
First Line	:	2106 IRONWOOD PASS DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3781
Country	:	US
Telephone Number	:	832-600-5144
Fax Number	:

Provider Business Practice Location Address
First Line	:	2106 IRONWOOD PASS DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3781
Country	:	US
Telephone Number	:	832-600-5144
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	BRENT EATON
Credential	:
Telephone Number	:	832-600-5144

Provider Enumeration Date	:	01/11/2023
Last Update Date	:	01/11/2023

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Directions to “OPTIMUM HEALTH TELEHEALTH SERVICES ” Practice Location

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