Healthcare Provider Details

I. General information

NPI: 1336075944
Provider Name (Legal Business Name): NATIONAL VISION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3293 W NORVELL BRYANT HWY
LECANTO FL
34461
US

IV. Provider business mailing address

2000 NEWPOINT PKWY STE 100
LAWRENCEVILLE GA
30043-5582
US

V. Phone/Fax

Practice location:
  • Phone: 352-513-6355
  • 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: MANAGED CARE DIRECTOR
Credential:
Phone: 404-775-9182