Healthcare Provider Details

I. General information

NPI: 1528136264
Provider Name (Legal Business Name): LUXOTTICA RETAIL NORTH AMERICA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 06/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12830 WALKER BRANCH RD
CHARLOTTE NC
28273-8850
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 704-583-0341
  • Fax:
Mailing address:
  • Phone: 704-583-0341
  • 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: MR. TERRY KROTH
Title or Position: SPECIALIST
Credential:
Phone: 513-765-3060