MEDICARE: OPTIMUM CARE LLC

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	:	1285494765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM CARE LLC

Provider Business Mailing Address
First Line	:	1880 S DAIRY ASHFORD RD STE 207
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-4759
Country	:	US
Telephone Number	:	214-202-9640
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 S DAIRY ASHFORD RD STE 207
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-4759
Country	:	US
Telephone Number	:	214-202-9640
Fax Number	:

Authorized Official
Title or Position	:	APRN
Name	:	JULIET C NWOKEDI
Credential	:	NP
Telephone Number	:	214-202-9640

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	03/20/2024

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Directions to “OPTIMUM CARE LLC ” Practice Location

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