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	:	1750844858
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	:	470-448-2092
Fax Number	:	770-220-1969

Provider Business Practice Location Address
First Line	:	1940 S MAIN ST
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5508
Country	:	US
Telephone Number	:	817-458-7790
Fax Number	:	817-599-6021

Authorized Official
Title or Position	:	MANAGED CARE SALES COORDINATOR
Name	:	GINA TAYLOR
Credential	:
Telephone Number	:	470-448-2092

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	04/08/2019

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Directions to “NATIONAL VISION INC ” Practice Location

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