Healthcare Provider Details

I. General information

NPI: 1720364532
Provider Name (Legal Business Name): OPTUM FRONTIER THERAPIES II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 SANTA MARGARITA ST UNIT 110
LAS VEGAS NV
89118-1913
US

IV. Provider business mailing address

1 OPTUM CIR STE 100
EDEN PRAIRIE MN
55344-2956
US

V. Phone/Fax

Practice location:
  • Phone: 702-954-8666
  • Fax: 702-634-5502
Mailing address:
  • Phone: 800-328-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DENISE MCCABE
Title or Position: SECRETARY
Credential:
Phone: 820-245-4968