Healthcare Provider Details

I. General information

NPI: 1285144345
Provider Name (Legal Business Name): LUXOTTICA RETAIL NORTH AMERICA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 W HERNDON AVE
CLOVIS CA
93612-0104
US

IV. Provider business mailing address

4000 LUXOTTICA PL ATTN MEDICARE DEPT
MASON OH
45040-8114
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-1354
  • Fax:
Mailing address:
  • Phone: 513-765-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: SUSAN M. KINSEY
Title or Position: VP, CONTROLLER FINANCE
Credential:
Phone: 513-765-6331