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General NPI Number Information
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NPI Number | 1669602165
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Entity Type | Organization
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Legal Business Name | OPTUM INFUSION SERVICES 402, LLC
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 2300 MAIN ST STE 150
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City | IRVINE
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State | CA
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Zip | 92614-6223
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Country | US
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Telephone | 562-263-5600
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Fax | 866-476-2489
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Provider Business Mailing Address
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Address Line | 1 OPTUM CIR STE 100
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-2503
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Country | US
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Telephone | 800-328-5979
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | KEVIN EUGENE BURR
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Credential |
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Telephone | 712-310-4701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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