Basic Information
| Provider Information | |||||||||
| NPI: | 1003821737 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | USV OPTICAL INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | US VISION OPTICAL INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HARMON DR | ||||||||
| Address2: | |||||||||
| City: | BLACKWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080125103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562281000 | ||||||||
| FaxNumber: | 8562277119 | ||||||||
| Practice Location | |||||||||
| Address1: | 2910 N. 5TH ST. HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109292531 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 02/11/2020 | ||||||||
| NPIReactivationDate: | 11/18/2021 | ||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HAYES | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 4808354470 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | PA | N | Suppliers | Eyewear Supplier (Equipment, not the service) | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.