MEDICARE: OPTIMA HEALTH PLAN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208000000X	Pediatrics Physician
3	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1679294201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMA HEALTH PLAN

Provider Business Mailing Address
First Line	:	701 S MAIN ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23523-1245
Country	:	US
Telephone Number	:	757-388-1830
Fax Number	:	855-939-7176

Provider Business Practice Location Address
First Line	:	701 S MAIN ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23523-1245
Country	:	US
Telephone Number	:	757-388-1830
Fax Number	:	855-939-7176

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DORIS PRINCE
Credential	:
Telephone Number	:	757-983-5475

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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Directions to “OPTIMA HEALTH PLAN ” Practice Location

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