Provider Demographics
NPI:1821304718
Name:LUXOTTICA RETAIL NORTH AMERICA INC
Entity Type:Organization
Organization Name:LUXOTTICA RETAIL NORTH AMERICA INC
Other - Org Name:TARGET OPTICAL #C4961
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-3060
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:650-212-0941
Mailing Address - Fax:
Practice Address - Street 1:2220 BRIDGEPOINTE PKWY
Practice Address - Street 2:SAN MATEO FASHION ISLAND
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1569
Practice Address - Country:US
Practice Address - Phone:650-212-0941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0180152671Medicare NSC