Provider Demographics
NPI:1538616123
Name:LUXOTTICA RETAIL NORTH AMERICA
Entity type:Organization
Organization Name:LUXOTTICA RETAIL NORTH AMERICA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BURMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-4128
Mailing Address - Street 1:4000 LUXOTTICA PL ATTN MEDICARE DEPT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:513-765-6000
Mailing Address - Fax:
Practice Address - Street 1:1050 FORDING ISLAND RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8664
Practice Address - Country:US
Practice Address - Phone:843-815-3767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2021-08-17
Deactivation Date:2020-04-02
Deactivation Code:
Reactivation Date:2021-08-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier