Optimum Vitality Medical Group

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

OPTIMUM VITALITY MEDICAL GROUP

Practice address

464 Richmond Rd Ste 202
Richmond Heights, OH 44143-2704

Phone

(330) 824-4200

Fax

(440) 525-5564

NPI assigned

Aug 30, 2019

Organization subpart

No

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

Authorized official

Name

Kelli Black

Title

Billing Consultant

Phone

(216) 750-3427

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1567123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567123200000",
    "number": "1780232843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "464 RICHMOND RD STE 202",
            "city": "RICHMOND HEIGHTS",
            "state": "OH",
            "postal_code": "441432704",
            "telephone_number": "330-824-4200",
            "fax_number": "440-525-5564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464 RICHMOND RD STE 202",
            "city": "RICHMOND HEIGHTS",
            "state": "OH",
            "postal_code": "441432704",
            "telephone_number": "330-824-4200",
            "fax_number": "440-525-5564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM VITALITY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-30",
        "last_updated": "2019-08-30",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "BILLING CONSULTANT",
        "authorized_official_telephone_number": "216-750-3427"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ohio CVS Stores LLC (CVS Pharmacy #03032)
• Ohio Physical Therapy Services of Mayfield Heights, LLC (Ohio Physical Therapy Services of Richmond Heights)
• Vivian Nnenna Omeike, PT
• Yetunde Omoniwa
• Open Hands of Caring Penn Foundation
• Bonnie Ann Owen, PA-C
• Roseline Ifedayo Oyebanji
• Barbara A. Palmer
• Shaniece Parker
• Antoinette Peterkin

• Clinic/Center in Richmond Heights, OH
• Providers in Richmond Heights, OH by specialty
• Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2019; 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.