| Optimal Health Clinic Inc | |
|
28315 S Tamiami Trl Ste 101 Bonita Springs FL 34134-3217 | |
| (239) 947-1177 | |
| Not Available |
| Full Name | Optimal Health Clinic Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 28315 S Tamiami Trl Ste 101, Bonita Springs, Florida |
| Authorized Official Name and Position | Gary Gendron (OWNER) |
| Authorized Official Contact | 2359471177 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimal Health Clinic Inc 28315 S Tamiami Trl Ste 101 Bonita Springs FL 34134-3217 Ph: (239) 947-1177 | Optimal Health Clinic Inc 28315 S Tamiami Trl Ste 101 Bonita Springs FL 34134-3217 Ph: (239) 947-1177 |
| NPI Number | 1750971404 |
|---|---|
| Provider Enumeration Date | 01/26/2021 |
| Last Update Date | 01/26/2021 |
| Medicare PECOS PAC ID | 0244644003 |
|---|---|
| Medicare Enrollment ID | O20210208000422 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750971404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Gary Gendron |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1982673547 PECOS PAC ID: 1658364096 Enrollment ID: I20100915000971 |
| Provider Name | Susie T Hemberger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942749627 PECOS PAC ID: 5496014433 Enrollment ID: I20180119000170 |
| Provider Name | Kelly Marie Forte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457953820 PECOS PAC ID: 6002223955 Enrollment ID: I20210322001379 |
| Provider Name | Jennifer R Landberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922501139 PECOS PAC ID: 4981950631 Enrollment ID: I20210827001104 |
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