Healthcare Provider Details

I. General information

NPI: 1437403359
Provider Name (Legal Business Name): NATIONAL VISION OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAIN EXCHANGE BLDG. 260
WHITE SANDS MISSILE RANGE NM
88002
US

IV. Provider business mailing address

296 GRAYSON HWY
LAWRENCEVILLE GA
30046-5737
US

V. Phone/Fax

Practice location:
  • Phone: 575-674-1280
  • Fax: 575-652-4623
Mailing address:
  • Phone: 770-822-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
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