Healthcare Provider Details

I. General information

NPI: 1962323238
Provider Name (Legal Business Name): NATIONAL VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10861 E SOUTHERN AVE
MESA AZ
85209-3907
US

IV. Provider business mailing address

2000 NEWPOINT PKWY
LAWRENCEVILLE GA
30043-5577
US

V. Phone/Fax

Practice location:
  • Phone: 602-794-8980
  • Fax:
Mailing address:
  • Phone: 800-571-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: LEAHANN RENE VAUGHN
Title or Position: MC SALES
Credential:
Phone: 404-775-9182