Provider Demographics
NPI:1134141237
Name:USV OPTICAL INC
Entity Type:Organization
Organization Name:USV OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL RELATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-228-1000
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:856-718-3572
Practice Address - Street 1:1105 MELBOURNE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-6211
Practice Address - Country:US
Practice Address - Phone:817-284-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
TX332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0324250189Medicare NSC