MEDICARE: NATIONAL VISION, INC.

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	1000070536	NV
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1194871822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL VISION, INC.

Provider Business Mailing Address
First Line	:	296 GRAYSON HIGHWAY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046
Country	:	US
Telephone Number	:	770-822-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 EAST TROPICANA AVENUE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121
Country	:	US
Telephone Number	:	702-451-2020
Fax Number	:	702-435-8492

Authorized Official
Title or Position	:	SR. VICE PRESIDENT, PROFESSIONAL SE
Name	:	MR. ROBERT W. STEIN
Credential	:
Telephone Number	:	770-822-3600

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	01/04/2010

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