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General NPI Number Information
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NPI Number | 1669127833
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Entity Type | Organization
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Legal Business Name | GRAND VISION USA RETAIL HOLDING CORPORATION
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 15 N BUFFALO GROVE RD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1701
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Country | US
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Telephone | 309-832-7038
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 SW 160TH AVE STE 400
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City | MIRAMAR
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State | FL
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Zip | 33027-6312
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Country | US
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Telephone | 305-557-9004
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Fax |
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Authorized Official
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Title or Position | VP. OF MANAGAED VISION CARE
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Name | MARIA OLIVER OLIVER
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Credential |
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Telephone | 513-292-4137
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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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