NPIMap

Organization Active NPI

Optimal Health Clinic Inc

  • Multi-Specialty Clinic/Center
  • Bonita Springs, FL
National Provider Identifier
1750971404
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
OPTIMAL HEALTH CLINIC INC
Practice address
28315 S Tamiami TRL Ste 101
Bonita Springs, FL 34134-3217
Phone
(239) 947-1177
NPI assigned
Jan 26, 2021
Last updated
Jan 26, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gary Gendron, DCNPI 1982673547
Title
Owner
Phone
(235) 947-1177

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

28315 S Tamiami TRL Ste 101
Bonita Springs, FL 34134-3217

Mailing address

28315 S Tamiami TRL Ste 101
Bonita Springs, FL 34134-3217
Phone (239) 947-1177

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL office Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Locations

28315 S Tamiami Trl
Ste 101
Bonita Springs, FL 34134
Phone (239) 947-1177

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611619200000",
    "number": "1750971404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28315 S TAMIAMI TRL STE 101",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341343217",
            "telephone_number": "239-947-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28315 S TAMIAMI TRL STE 101",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341343217",
            "telephone_number": "239-947-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL HEALTH CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-26",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A",
        "authorized_official_last_name": "GENDRON",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "235-947-1177",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "office",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "28315 S Tamiami Trl Ste 101",
            "city": "Bonita Springs",
            "state": "FL",
            "country_code": "US",
            "postal_code": "341343217",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bonita Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.