Healthcare Provider Details

I. General information

NPI: 1205507332
Provider Name (Legal Business Name): NATIONAL VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CBL DRIVE SUITE 109
ST. AUGUSTINE FL
32086
US

IV. Provider business mailing address

2435 COMMERCE AVE
DULUTH GA
30096-4980
US

V. Phone/Fax

Practice location:
  • Phone: 904-506-6453
  • 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: JULIE GARRISON
Title or Position: MANAGED CARE STORE ENROLLMENT
Credential:
Phone: 770-822-3600