Provider Demographics
NPI:1972678324
Name:LUXOTTICA RETAIL NORTH AMERICA INC
Entity Type:Organization
Organization Name:LUXOTTICA RETAIL NORTH AMERICA INC
Other - Org Name:SEARS OPTICAL 1339
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:703-914-2358
Mailing Address - Fax:
Practice Address - Street 1:5901 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3211
Practice Address - Country:US
Practice Address - Phone:703-914-2358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0180151236Medicare NSC