Healthcare Provider Details

I. General information

NPI: 1477607521
Provider Name (Legal Business Name): NATIONAL VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 01/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4957 CLEVELAND AVENUE
FORT MEYERS FL
33907
US

IV. Provider business mailing address

296 GRAYSON HIGHWAY
LAWRENCEVILLE GA
30046
US

V. Phone/Fax

Practice location:
  • Phone: 239-278-1217
  • Fax: 239-278-4477
Mailing address:
  • Phone: 770-822-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number611992
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

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