=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275214082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | USV OPTICAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2023
-----------------------------------------------------
Last Update Date | 08/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 E MERRITT ISLAND CSWY
-----------------------------------------------------
City | MERRITT ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32952-3576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-452-6811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 HARMON DR
-----------------------------------------------------
City | BLACKWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08012-5103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-228-1000
-----------------------------------------------------
Fax | 856-718-3639
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE VICE PRESIDENT
-----------------------------------------------------
Name | MICHAEL PASQUALE DERENZO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-228-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------