Provider Demographics
NPI: | 1275854077 |
---|---|
Name: | COLE VISION CORPORATION |
Entity Type: | Organization |
Organization Name: | COLE VISION CORPORATION |
Other - Org Name: | SEARS OPTICAL #C0870 |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MEDICARE ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | WENDY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | UHLS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 513-765-3534 |
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: | 45040-8114 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 321-768-9239 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1050 S BABCOCK ST |
Practice Address - Street 2: | |
Practice Address - City: | MELBOURNE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32901-3022 |
Practice Address - Country: | US |
Practice Address - Phone: | 321-768-9239 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-06-15 |
Last Update Date: | 2010-06-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332H00000X | Suppliers | Eyewear Supplier |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 0507950773 | Medicare NSC |