Provider Demographics
NPI:1972655413
Name:LUXOTTICA RETAIL NORTH AMERICA, INC
Entity Type:Organization
Organization Name:LUXOTTICA RETAIL NORTH AMERICA, INC
Other - Org Name:TARGET OPTICAL #2096
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CONTROLLER FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-6331
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:952-226-1411
Mailing Address - Fax:
Practice Address - Street 1:14333 HIGHWAY 13 S
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378
Practice Address - Country:US
Practice Address - Phone:952-226-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0180151828Medicare NSC