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General NPI Number Information
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NPI Number | 1104857929
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Entity Type | Organization
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Legal Business Name | NATIONAL VISION, INC.
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 3118 DONNELL DR
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City | FORESTVILLE
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State | MD
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Zip | 20747-3203
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Country | US
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Telephone | 301-735-5600
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Fax | 301-735-8213
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Provider Business Mailing Address
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Address Line | 2435 COMMERCE AVE BLDG 2200
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City | DULUTH
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State | GA
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Zip | 30096-4980
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Country | US
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Telephone | 770-822-3600
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Fax |
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Authorized Official
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Title or Position | PROVIDER NETWORK MANAGER
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Name | LEAHANN RENE VAUGHN
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Credential |
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Telephone | 470-448-2782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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