Healthcare Provider Details

I. General information

NPI: 1801463856
Provider Name (Legal Business Name): NATIONAL VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 HIGHWAY 90
PACE FL
32571-1401
US

IV. Provider business mailing address

2435 COMMERCE AVE
DULUTH GA
30096-4980
US

V. Phone/Fax

Practice location:
  • Phone: 850-463-9300
  • Fax:
Mailing address:
  • Phone: 678-892-3771
  • 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: DIRECTOR OF MANAGED CARE SALES
Credential:
Phone: 470-448-2782