Healthcare Provider Details

I. General information

NPI: 1063468957
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: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 NEW FRANKLIN RD
LAGRANGE GA
30240-1843
US

IV. Provider business mailing address

296 GRAYSON HWY
LAWRENCEVILLE GA
30046-5737
US

V. Phone/Fax

Practice location:
  • Phone: 706-885-1444
  • Fax:
Mailing address:
  • Phone: 770-822-3600
  • 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: LEAHANN VAUGHN
Title or Position: MANAGED CARE SALES COORDINATOR
Credential:
Phone: 678-892-3760