Basic Information
| Provider Information | |||||||||
| NPI: | 1447300199 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LUXOTTICA RETAIL NORTH AMERICA INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TARGET OPTICAL #4008 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 LUXOTTICA PL | ||||||||
| Address2: | ATTN MEDICARE DEPT | ||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450408114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017764426 | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 W 2000 N | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017764426 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 06/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | KROTH | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5137653060 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.