Provider Demographics
NPI:1669127833
Name:GRAND VISION USA RETAIL HOLDING CORPORATION
Entity type:Organization
Organization Name:GRAND VISION USA RETAIL HOLDING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP. OF MANAGAED VISION CARE
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-292-4137
Mailing Address - Street 1:3601 SW 160TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6312
Mailing Address - Country:US
Mailing Address - Phone:305-557-9004
Mailing Address - Fax:
Practice Address - Street 1:15 N BUFFALO GROVE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1701
Practice Address - Country:US
Practice Address - Phone:309-832-7038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier