Healthcare Provider Details

I. General information

NPI: 1508803917
Provider Name (Legal Business Name): NATIONAL VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 GRAYSON RD
HARRISBURG PA
17111-5141
US

IV. Provider business mailing address

PO BOX 951336
DALLAS TX
75395-1336
US

V. Phone/Fax

Practice location:
  • Phone: 717-561-2980
  • 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 Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN EDICK
Title or Position: MC ASST
Credential:
Phone: 678-892-3774