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Organization

OPTUMCARE NEW MEXICO, LLC

Active
Other names
DaVita Medical Group
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN G LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization

Contact information

Practice address
5150 JOURNAL CENTER BLVD NE, ALBUQUERQUE, NM 87109-5900
(505) 262-3370
(505) 262-3226
Mailing address
PO BOX 26028, ALBUQUERQUE, NM 87125-6028
(505) 262-7960

Taxonomy

Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary

Other

Enumeration date
09/27/2011
Last updated
08/22/2019
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