1700936465 NPI number — LUXOTTICA RETAIL NORTH AMERICA INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700936465 NPI number — LUXOTTICA RETAIL NORTH AMERICA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUXOTTICA RETAIL NORTH AMERICA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TARGET OPTICAL #4011
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700936465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 LUXOTTICA PL
Provider Second Line Business Mailing Address:
ATTN MEDICARE DEPT
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-8114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-248-9903
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15700 SHAWNEE MISSION PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAWNEE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66217-9321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-248-9903
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KROTH
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
SPECIALIST
Authorized Official Telephone Number:
513-765-3060

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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