Healthcare Provider Details

I. General information

NPI: 1104857929
Provider Name (Legal Business Name): NATIONAL VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 DONNELL DR
FORESTVILLE MD
20747-3203
US

IV. Provider business mailing address

2435 COMMERCE AVE BLDG 2200
DULUTH GA
30096-4980
US

V. Phone/Fax

Practice location:
  • Phone: 301-735-5600
  • Fax: 301-735-8213
Mailing address:
  • Phone: 770-822-3600
  • 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: PROVIDER NETWORK MANAGER
Credential:
Phone: 470-448-2782