Healthcare Provider Details

I. General information

NPI: 1639850431
Provider Name (Legal Business Name): USV OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 W ARROWHEAD TOWNE CTR
GLENDALE AZ
85308-8612
US

IV. Provider business mailing address

1 HARMON DR
BLACKWOOD NJ
08012-5103
US

V. Phone/Fax

Practice location:
  • Phone: 623-412-1121
  • Fax:
Mailing address:
  • Phone: 856-228-1000
  • Fax: 856-718-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PASQUALE DERENZO
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 856-228-1000