Provider Demographics
NPI:1518073469
Name:US VISION OPTICAL INC
Entity Type:Organization
Organization Name:US VISION OPTICAL INC
Other - Org Name:MARSHALL FIELDS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROF REL MGR
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 1:10 HARMON DR
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-5104
Mailing Address - Country:US
Mailing Address - Phone:856-228-1000
Mailing Address - Fax:856-227-7119
Practice Address - Street 1:18000 VERNIER RD
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1046
Practice Address - Country:US
Practice Address - Phone:313-245-2183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0324250574Medicare NSC