Healthcare Provider Details

I. General information

NPI: 1518073469
Provider Name (Legal Business Name): US VISION OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18000 VERNIER RD
HARPER WOODS MI
48225-1046
US

IV. Provider business mailing address

10 HARMON DR
BLACKWOOD NJ
08012-5104
US

V. Phone/Fax

Practice location:
  • Phone: 313-245-2183
  • Fax:
Mailing address:
  • Phone: 856-228-1000
  • Fax: 856-227-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: RANDI WOERNER
Title or Position: PROF REL MGR
Credential:
Phone: 856-228-1000