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NPI Code Detail

MEDICARE: NATIONAL VISION INC

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
1152W00000XOptometrist

General Provider Information

NPI Number : 1275168403
Entity Type Code : Organization
Provider Name (Legal Business Name) : NATIONAL VISION INC
Provider Business Mailing Address
First Line : 2435 COMMERCE AVE
Second Line :
City : DULUTH
State : GA
Zip : 30096-4980
Country : US
Telephone Number : 800-637-3597
Fax Number :
Provider Business Practice Location Address
First Line : 5609 SIERRA SPRINGS LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76123-2183
Country : US
Telephone Number : 682-610-6248
Fax Number :
Authorized Official
Title or Position : MANAGED CARE NETWORK SPRVSR
Name : LEAHANN RENE VAUGHN
Credential :
Telephone Number : 470-448-2782
Provider Enumeration Date : 03/09/2020
Last Update Date : 03/09/2020

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Directions to “NATIONAL VISION INC ” Practice Location

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