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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1659561868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL VISION, INC.

Provider Business Mailing Address
First Line	:	2435 COMMERCE AVE BLDG 2200
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4980
Country	:	US
Telephone Number	:	770-822-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 WALDORF MARKET PL STE 9
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4873
Country	:	US
Telephone Number	:	240-427-1915
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER NETWORK MANAGER
Name	:	LEAHANN RENE VAUGHN
Credential	:
Telephone Number	:	470-448-2782

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	03/25/2019

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