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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1548208457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL VISION, INC.

Provider Business Mailing Address
First Line	:	PO BOX 951336
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75395-1336
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 BLAIR MILL RD
Second Line	:
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-1729
Country	:	US
Telephone Number	:	215-659-2460
Fax Number	:

Authorized Official
Title or Position	:	MC ASST
Name	:	SUSAN EDICK
Credential	:
Telephone Number	:	678-892-3774

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	10/24/2011

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