Provider Demographics
NPI:1881044329
Name:LUXOTTICA RETAIL NORTH AMERICA INC
Entity Type:Organization
Organization Name:LUXOTTICA RETAIL NORTH AMERICA INC
Other - Org Name:TARGET OPTICAL #4820
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BURMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-4128
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:513-765-6000
Mailing Address - Fax:
Practice Address - Street 1:1650 S MILTON RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-0802
Practice Address - Country:US
Practice Address - Phone:928-864-5306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier