Provider Demographics
NPI:1821727611
Name:USV OPTICAL, INC.
Entity Type:Organization
Organization Name:USV OPTICAL, INC.
Other - Org Name:FORWARD VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PASQUALE
Authorized Official - Last Name:DERENZO
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:
Practice Address - Street 1:10049 CLEARY BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1063
Practice Address - Country:US
Practice Address - Phone:954-472-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier