Organization
OPTIMA MEDICAL GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRETT J BOLTE M.D. (PRESIDENT)
(254) 783-1885
Entity
Organization
Contact information
Practice address
2115 N 34TH ST, SUITE B, WACO, TX 76708-3114
(254) 753-1885
(254) 755-0078
Mailing address
2115 N 34TH ST, SUITE B, WACO, TX 76708-3114
(254) 753-1885
(254) 755-0078
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G14L
BLUE CROSS BLUE SHIELD
TX
Enumeration date
03/06/2007
Last updated
08/22/2020
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