Healthcare Provider Details

I. General information

NPI: 1538988654
Provider Name (Legal Business Name): NATIONAL VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E 14 MILE RD
MADISON HEIGHTS MI
48071-1301
US

IV. Provider business mailing address

2435 COMMERCE AVE BLDG 2200
DULUTH GA
30096-4980
US

V. Phone/Fax

Practice location:
  • Phone: 248-591-4147
  • Fax:
Mailing address:
  • Phone: 678-892-3760
  • 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: MDG CARE SALES DIRECTOR
Credential:
Phone: 470-448-2782