Provider Demographics
NPI:1285799346
Name:LUXOTTICA RETAIL NORTH AMERICA INC
Entity type:Organization
Organization Name:LUXOTTICA RETAIL NORTH AMERICA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:810-732-4110
Mailing Address - Fax:
Practice Address - Street 1:3405 S LINDEN RD
Practice Address - Street 2:GENESEE VALLEY MALL
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3009
Practice Address - Country:US
Practice Address - Phone:810-732-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0180152390Medicare NSC