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

General Provider Information

NPI Number	:	1780605832
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	:	7601 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-1022
Country	:	US
Telephone Number	:	773-581-8318
Fax Number	:

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	01/23/2020

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