MEDICARE: USV OPTICAL, INC.

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1164174603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USV OPTICAL, INC.

Provider Business Mailing Address
First Line	:	1 HARMON DR
Second Line	:
City	:	BLACKWOOD
State	:	NJ
Zip	:	08012-5103
Country	:	US
Telephone Number	:	856-228-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 SAINT CHARLES CT STE 1008
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2180
Country	:	US
Telephone Number	:	407-333-2740
Fax Number	:

Authorized Official
Title or Position	:	PROFESSIONAL RELATIONS MANAGER
Name	:	RANDI WOERNER
Credential	:
Telephone Number	:	856-228-1000

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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Directions to “USV OPTICAL, INC. ” Practice Location

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