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	:	1689739922
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	:	989-684-9233
Fax Number	:	989-684-6597

Provider Business Practice Location Address
First Line	:	4101 WILDER RD
Second Line	:	BAY CITY MALL STE #B211
City	:	BAY CITY
State	:	MI
Zip	:	48706-2214
Country	:	US
Telephone Number	:	989-684-9233
Fax Number	:	989-684-6597

Authorized Official
Title or Position	:	MEDICARE SUPERVISOR
Name	:	MS. WENDY UHLS
Credential	:
Telephone Number	:	513-765-3534

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	08/05/2009

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