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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