MEDICARE: LUXOTTICA RETAIL NORTH AMERICA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1376695346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUXOTTICA RETAIL NORTH AMERICA INC

Provider Business Mailing Address
First Line	:	4000 LUXOTTICA PL
Second Line	:	ATTN MEDICARE DEPT
City	:	MASON
State	:	OH
Zip	:	45040-8114
Country	:	US
Telephone Number	:	904-596-1068
Fax Number	:

Provider Business Practice Location Address
First Line	:	6331 ROOSEVELT BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-3303
Country	:	US
Telephone Number	:	904-596-1068
Fax Number	:

Authorized Official
Title or Position	:	MEDICARE ADMINISTRATOR
Name	:	MS. WENDPY UHLS
Credential	:
Telephone Number	:	513-765-3534

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	10/21/2009

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