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NPI Code Detail

MEDICARE: USV OPTICAL INC.

MEDICARE: USV OPTICAL 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
1332H00000XEyewear Supplier

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11578891008OTHERBILLING NPI

General Provider Information

NPI Number : 1588939375
Entity Type Code : Organization
Provider Name (Legal Business Name) : USV OPTICAL INC.
Provider Business Mailing Address
First Line : 1 HARMON DR
Second Line :
City : BLACKWOOD
State : NJ
Zip : 08012-5103
Country : US
Telephone Number : 856-228-1000
Fax Number : 856-718-3572
Provider Business Practice Location Address
First Line : 3700 17 MILE RD
Second Line :
City : CEDAR SPRINGS
State : MI
Zip : 49319-7974
Country : US
Telephone Number : 616-696-2965
Fax Number :
Authorized Official
Title or Position : PROFESSIONAL RELATIONS MANAGER
Name : RANDI WOERNER
Credential :
Telephone Number : 856-228-1000
Provider Enumeration Date : 03/13/2012
Last Update Date : 02/05/2020

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