Healthcare Provider Details

I. General information

NPI: 1629016381
Provider Name (Legal Business Name): NATIONAL VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EUBANK BLVD NE
ALBUQUERQUE NM
87123-2758
US

IV. Provider business mailing address

PO BOX 951336
DALLAS TX
75395-1336
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-1142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: LEAHANN RENE VAUGHN
Title or Position: DIRECTOR
Credential:
Phone: 470-448-2782