Healthcare Provider Details

I. General information

NPI: 1720133549
Provider Name (Legal Business Name): NATIONAL VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 WYOMING BOULEVARD NE
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

296 GRAYSON HIGHWAY
LAWRENCEVILLE GA
30046
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-0955
  • Fax: 505-294-0950
Mailing address:
  • Phone: 770-822-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberFA0051597
License Number StateNM
# 3
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