MEDICARE: OPTUM HEART AND VASCULAR CENTER, 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1518770577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM HEART AND VASCULAR CENTER, LLC

Provider Business Mailing Address
First Line	:	2724 N TENAYA WAY STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2724 N TENAYA WAY STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0424
Country	:	US
Telephone Number	:	435-565-0704
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	JESSICA LYON
Credential	:
Telephone Number	:	725-301-3516

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	04/17/2026

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