Healthcare Provider Details

I. General information

NPI: 1174131742
Provider Name (Legal Business Name): NATIONAL VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 E MAIN ST
PLAINFIELD IN
46168-2759
US

IV. Provider business mailing address

2435 COMMERCE AVE
DULUTH GA
30096-4980
US

V. Phone/Fax

Practice location:
  • Phone: 317-754-3014
  • Fax:
Mailing address:
  • Phone: 800-637-3597
  • Fax: 770-220-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LEAHANN RENE VAUGHN
Title or Position: MANAGED CARE SALES NETWORK SPRVSR
Credential:
Phone: 470-448-2782