Provider Demographics
NPI:1720278153
Name:LUXOTTICA RETAIL NORTH AMERICA INC
Entity Type:Organization
Organization Name:LUXOTTICA RETAIL NORTH AMERICA INC
Other - Org Name:PEARLE VISION #C6625
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:414-764-2651
Mailing Address - Fax:
Practice Address - Street 1:8907 HOWELL AVE
Practice Address - Street 2:OAK CREEK TARGET CTR STE #600
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4460
Practice Address - Country:US
Practice Address - Phone:414-764-2651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0180152069Medicare NSC