Healthcare Provider Details

I. General information

NPI: 1437651015
Provider Name (Legal Business Name): USV OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 S 7TH ST
BISMARCK ND
58504-5859
US

IV. Provider business mailing address

1 HARMON DR
BLACKWOOD NJ
08012-5103
US

V. Phone/Fax

Practice location:
  • Phone: 701-255-8490
  • Fax:
Mailing address:
  • Phone: 856-228-1000
  • Fax: 856-718-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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