MEDICARE: NATIONAL VISION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1083553978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL VISION, INC.

Provider Business Mailing Address
First Line	:	2435 COMMERCE AVE BLDG 2200
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4980
Country	:	US
Telephone Number	:	470-448-2092
Fax Number	:	470-448-2092

Provider Business Practice Location Address
First Line	:	121 HIGHWAY 332 W STE D
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-4099
Country	:	US
Telephone Number	:	979-258-7716
Fax Number	:

Authorized Official
Title or Position	:	MANAGED CARE DIRECTOR
Name	:	LEAHANN RENE VAUGHN
Credential	:
Telephone Number	:	404-775-9182

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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