Healthcare Provider Details

I. General information

NPI: 1346296167
Provider Name (Legal Business Name): NATIONAL VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 HABERSHAM HILLS CIR
CORNELIA GA
30531-5388
US

IV. Provider business mailing address

PO BOX 951336
DALLAS TX
75395-1336
US

V. Phone/Fax

Practice location:
  • Phone: 706-778-2149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANNA PURCELL
Title or Position: PROVIDER NETWORK ADMINISTRATOR
Credential:
Phone: 770-822-4245