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General NPI Number Information
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NPI Number | 1003971243
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Entity Type | Organization
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Legal Business Name | LUXOTTICA RETAIL NORTH AMERICA INC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 02/09/2010
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Provider Practice Location Address
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Address Line | 4024 ELKHARTE RD GOSHEN MARKET CTR STE #23
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City | GOSHEN
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State | IN
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Zip | 46526-5807
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Country | US
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Telephone | 574-875-5042
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 LUXOTTICA PL ATTN MEDICARE DEPT
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City | MASON
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State | OH
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Zip | 45040-8114
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Country | US
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Telephone | 574-875-5042
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Fax |
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Authorized Official
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Title or Position | MEDICARE ADMINISTRATOR
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Name | MS. WENDY UHLS
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Credential |
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Telephone | 513-765-3534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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