Provider Demographics
NPI:1952455289
Name:LUXOTTICA RETAIL NORTH AMERICA INC
Entity Type:Organization
Organization Name:LUXOTTICA RETAIL NORTH AMERICA INC
Other - Org Name:LENSCRAFTERS OPTIQUE AT MACY'S #1691
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:480-840-0333
Mailing Address - Fax:
Practice Address - Street 1:7014 E CAMELBACK RD
Practice Address - Street 2:SCOTTSDALE FASHION SQUARE
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1227
Practice Address - Country:US
Practice Address - Phone:480-840-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0180151012Medicare NSC