MEDICARE: LUXOTTICA RETAIL NORTH AMERICA 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	:	1528116100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUXOTTICA RETAIL NORTH AMERICA INC

Provider Business Mailing Address
First Line	:	4000 LUXOTTICA PL
Second Line	:	ATTN MEDICARE DEPT
City	:	MASON
State	:	OH
Zip	:	45040-8114
Country	:	US
Telephone Number	:	760-352-6788
Fax Number	:

Provider Business Practice Location Address
First Line	:	3751 S DOGWOOD RD
Second Line	:	IMPERIAL VALLEY MALL
City	:	EL CENTRO
State	:	CA
Zip	:	92243-9688
Country	:	US
Telephone Number	:	760-352-6788
Fax Number	:

Authorized Official
Title or Position	:	SPECIALIST
Name	:	MR. TERRY KROTH
Credential	:
Telephone Number	:	513-765-3060

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	06/13/2013

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