Provider Demographics
NPI:1639191422
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 1:700 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4200
Practice Address - Country:US
Practice Address - Phone:248-583-1124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2023-07-18
Deactivation Date:2020-02-10
Deactivation Code:
Reactivation Date:2021-11-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0324250211Medicare NSC