Provider Demographics
NPI:1003821737
Name:USV OPTICAL INC.
Entity Type:Organization
Organization Name:USV OPTICAL INC.
Other - Org Name:US VISION OPTICAL INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT OF MANAGED CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-835-4470
Mailing Address - Street 1:1 HARMON DR
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-5103
Mailing Address - Country:US
Mailing Address - Phone:856-228-1000
Mailing Address - Fax:856-227-7119
Practice Address - Street 1:2910 N. 5TH ST. HIGHWAY
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605
Practice Address - Country:US
Practice Address - Phone:610-929-2531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2021-11-18
Deactivation Date:2020-02-11
Deactivation Code:
Reactivation Date:2021-11-18
Provider Licenses
StateLicense IDTaxonomies
PA332H00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0324250984Medicare NSC