MEDICARE: OPTUMCARE MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site	C38824	CA

General Provider Information

NPI Number	:	1023339165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUMCARE MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 6400
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-6400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 LAKEWOOD BLVD
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2412
Country	:	US
Telephone Number	:	562-361-5650
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	JOHN G. LIETHEN
Credential	:
Telephone Number	:	952-205-6262

Provider Enumeration Date	:	06/11/2010
Last Update Date	:	08/19/2019

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