Provider Demographics
NPI:1366850067
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:856-227-7119
Practice Address - Street 1:11305 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2070
Practice Address - Country:US
Practice Address - Phone:815-464-5448
Practice Address - Fax:815-464-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
IL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578891008OtherBILLING NPI