Healthcare Provider Details

I. General information

NPI: 1982921813
Provider Name (Legal Business Name): COLE VISION CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 DONALD LYNCH BLVD SOLOMON POND MALL
MARLBOROUGH MA
01752-4725
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 508-357-6268
  • Fax:
Mailing address:
  • Phone: 508-357-6268
  • 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: WENDY UHLS
Title or Position: MEDICARE ADMINISTRATOR
Credential:
Phone: 513-765-3534