Basic Information
| Provider Information | |||||||||
| NPI: | 1548446990 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | USV OPTICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HARMON DR | ||||||||
| Address2: | |||||||||
| City: | BLACKWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080125103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562281000 | ||||||||
| FaxNumber: | 8567183572 | ||||||||
| Practice Location | |||||||||
| Address1: | 5651 HWY 95 NORTH | ||||||||
| Address2: | |||||||||
| City: | LAKE HAVASU | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287642385 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | WOERNER | ||||||||
| AuthorizedOfficialFirstName: | RANDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROFESSIONAL RELATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8562281000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
ID Information
| ID | Type | State | Issuer | Description | 157891008 | 01 | BILLING NPI | OTHER |