Optim Ketamine Clinics LLC

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

OPTIM KETAMINE CLINICS LLC

Practice address

10255 N 32ND St Ste B
Phoenix, AZ 85028-3822

Phone

(928) 851-3733

NPI assigned

Oct 30, 2017

Last updated

Oct 30, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christopher S Ray, MD

Title

Director

Phone

(623) 293-3985

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509321600000",
    "number": "1770095820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20403 N LAKE PLEASANT RD # 117-480",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853829702",
            "telephone_number": "928-851-3733",
            "fax_number": "888-908-3894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10255 N 32ND ST STE B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850283822",
            "telephone_number": "928-851-3733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIM KETAMINE CLINICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-30",
        "last_updated": "2017-10-30",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "623-293-3985",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dana Matthew Opsahl, PHARMD
• Optical Design, Inc
• Optical Expressions PLLC
• Optima Laboratory LLC
• Optima Surgery Center of Arizona, LLC
• Optimal Behavioral Health Services
• Optimed Fitness Medical Rehab & Weight Loss Center, PC
• Optimum Anesthesia Services, Inc

• Infusion Therapy Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Infusion Therapy Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; 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.