Basic Information
| Provider Information | |||||||||
| NPI: | 1578940755 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | USV OPTICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HARMON DRIVE | ||||||||
| Address2: | |||||||||
| City: | BLACKWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562281000 | ||||||||
| FaxNumber: | 8567183572 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 W. WINTERS ST. | ||||||||
| Address2: | BLDG 1981 | ||||||||
| City: | SCOTT AFB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6187440277 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2015 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | WOERNER | ||||||||
| AuthorizedOfficialFirstName: | RANDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROFESSIONAL RELATIONS MANGER | ||||||||
| AuthorizedOfficialTelephone: | 8562281000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/31/2020 | ||||||||
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 | 1578891008 | 01 | BILLING NPI | OTHER |