MEDICARE: ENVISION OPTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1144747239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION OPTICS LLC

Provider Business Mailing Address
First Line	:	1943 PLEASANT HILL RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4625
Country	:	US
Telephone Number	:	404-448-4745
Fax Number	:	561-828-8367

Provider Business Practice Location Address
First Line	:	1943 PLEASANT HILL RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4625
Country	:	US
Telephone Number	:	404-448-4745
Fax Number	:	561-828-8367

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	JACKIE BENNETT
Credential	:
Telephone Number	:	561-433-6009

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	02/17/2021

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