=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013062637
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUXOTTICA OF AMERICA INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 09/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2852 E 3RD ST COLLEGE MALL STE #L07
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47401-5423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-334-1872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4000 LUXOTTICA PL ATTN MEDICARE DEPT
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45040-8114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-334-1872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO, NORTH AMERICA
-----------------------------------------------------
Name | EMILIA FLAMINI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-765-6623
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------