Healthcare Provider Details

I. General information

NPI: 1558302489
Provider Name (Legal Business Name): NATIONAL VISION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 EMILY DR
CLARKSBURG WV
26301-5508
US

IV. Provider business mailing address

2435 COMMERCE AVE BLDG 2200
DULUTH GA
30096-4980
US

V. Phone/Fax

Practice location:
  • Phone: 304-622-2494
  • Fax:
Mailing address:
  • Phone: 770-822-3600
  • 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: LEAHANN VAUGHN
Title or Position: MANAGED CARE SALES COORDINATOR
Credential:
Phone: 770-822-3600