Provider Demographics
NPI:1427435528
Name:USV OPTICAL INC.
Entity type:Organization
Organization Name:USV OPTICAL INC.
Other - Org Name:
Other - Org Type:
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:856-718-3572
Practice Address - Street 1:442 13TH ST
Practice Address - Street 2:BLDG. 266
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19902-6403
Practice Address - Country:US
Practice Address - Phone:302-730-8784
Practice Address - Fax:856-718-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578891008OtherBILLING NPI