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
1	332H00000X	Eyewear Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1578891008	OTHER		BILLING NPI

General Provider Information

NPI Number	:	1659725679
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	:	750 E ROLLINS RD
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-1340
Country	:	US
Telephone Number	:	847-740-5178
Fax Number	:	847-740-5274

Authorized Official
Title or Position	:	PROFESSIONAL RELATIONS MANAGER
Name	:	RANDI WOERNER
Credential	:
Telephone Number	:	856-228-1000

Provider Enumeration Date	:	04/15/2016
Last Update Date	:	01/31/2020

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Directions to “USV OPTICAL INC. ” Practice Location

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