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	156FX1800X	Optician

General Provider Information

NPI Number	:	1093169476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL VISION, INC.

Provider Business Mailing Address
First Line	:	2435 COMMERCE AVE
Second Line	:	BLDG 2200
City	:	DULUTH
State	:	GA
Zip	:	30096-4980
Country	:	US
Telephone Number	:	800-571-5202
Fax Number	:

Provider Business Practice Location Address
First Line	:	3625 MIDWAY DR
Second Line	:	SUITE P
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5253
Country	:	US
Telephone Number	:	619-321-4681
Fax Number	:	619-221-2990

Authorized Official
Title or Position	:	MANAGED CARE COORDINATOR
Name	:	LISA BAGGETT
Credential	:
Telephone Number	:	770-822-4203

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/21/2016

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