Healthcare Provider Details

I. General information

NPI: 1710921309
Provider Name (Legal Business Name): NATIONAL VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER BUILDING 9040
FT. LEWIS WA
98431
US

IV. Provider business mailing address

PO BOX 951336
DALLAS TX
75395-1336
US

V. Phone/Fax

Practice location:
  • Phone: 253-964-0258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANNA PURCELL
Title or Position: PROVIDER NETWORK ADMINISTRATOR
Credential:
Phone: 770-822-4245