Provider Demographics
NPI:1013393636
Name:LUXOTTICA RETAIL NORTH AMERICA
Entity Type:Organization
Organization Name:LUXOTTICA RETAIL NORTH AMERICA
Other - Org Name:TARGET 6756
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BURMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-4128
Mailing Address - Street 1:4000 LUXOTTICA PL
Mailing Address - Street 2:ATTN: MEDICARE DEPT
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:513-765-6000
Mailing Address - Fax:
Practice Address - Street 1:460 S VANCE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3305
Practice Address - Country:US
Practice Address - Phone:303-209-5133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier