Provider Demographics
NPI:1265444244
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: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:856-227-7119
Practice Address - Street 1:2501 MING AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-4146
Practice Address - Country:US
Practice Address - Phone:661-834-7446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2021-11-18
Deactivation Date:2020-02-03
Deactivation Code:
Reactivation Date:2021-11-18
Provider Licenses
StateLicense IDTaxonomies
332H00000X
CA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0324251111Medicare NSC