Healthcare Provider Details

I. General information

NPI: 1003827841
Provider Name (Legal Business Name): USV OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 MILAN RD
SANDUSKY OH
44870
US

IV. Provider business mailing address

1 HARMON DR
BLACKWOOD NJ
08012-5103
US

V. Phone/Fax

Practice location:
  • Phone: 419-626-4614
  • 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: RANDI WOERNER
Title or Position: PROFESSIONAL RELATIONS MANAGER
Credential:
Phone: 856-228-1000