Healthcare Provider Details

I. General information

NPI: 1093007460
Provider Name (Legal Business Name): OPTUM CARE WASHINGTON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 09/02/2025
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 NE 130TH LN STE 400
KIRKLAND WA
98034-3041
US

IV. Provider business mailing address

3901 HOYT AVE
EVERETT WA
98201-4918
US

V. Phone/Fax

Practice location:
  • Phone: 425-317-4641
  • Fax:
Mailing address:
  • Phone: 425-339-5460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD H COOPER
Title or Position: CEO
Credential:
Phone: 425-339-5460