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	611992	FL
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1477607521
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	:	4957 CLEVELAND AVENUE
Second Line	:
City	:	FORT MEYERS
State	:	FL
Zip	:	33907
Country	:	US
Telephone Number	:	239-278-1217
Fax Number	:	239-278-4477

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	01/02/2010

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