Organization Active NPI

Luxottica Retail North America Inc

Doing business as Pearle Vision #C6402

  • Eyewear Supplier
  • State College, PA
National Provider Identifier
1649334624
Registry record updated Jul 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
LUXOTTICA RETAIL NORTH AMERICA INC
Doing business as
Pearle Vision #C6402
Practice address
Nittany Mall
State College, PA 16801
Phone
(814) 234-3047
NPI assigned
Dec 21, 2006
Last updated
Jul 10, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Terry Kroth
Title
Specialist
Phone
(513) 765-3060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X NU Primary

Addresses

Primary practice location

Nittany Mall
State College, PA 16801

Mailing address

4000 Luxottica PL
Attn Medicare Dept
Mason, OH 45040-8114
Phone (513) 765-3534

Other names 1

  • PEARLE VISION #C6402 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040113000018 PA Part B Supplier - Clinic/Group Practice 2567366180 Receives reassigned benefits from 17 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Exton, PA; Lancaster, PA; North Wales, PA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373414400000",
    "number": "1649334624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 LUXOTTICA PL",
            "address_2": "ATTN MEDICARE DEPT",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450408114",
            "telephone_number": "513-765-3534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NITTANY MALL",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "16801",
            "telephone_number": "814-234-3047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUXOTTICA RETAIL NORTH AMERICA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2013-07-10",
        "status": "A",
        "authorized_official_last_name": "KROTH",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "SPECIALIST",
        "authorized_official_telephone_number": "513-765-3060",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEARLE VISION #C6402",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.