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	:	1477128510
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	:	678-892-3771
Fax Number	:

Provider Business Practice Location Address
First Line	:	3224 N POINCIANA BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-4688
Country	:	US
Telephone Number	:	407-861-5292
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE SALES
Name	:	LEAHANN RENE VAUGHN
Credential	:
Telephone Number	:	470-448-2782

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	05/21/2021

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