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	:	1609814516
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	:	2490 7TH ST
Second Line	:	AAFES BLDG. 372, SUITE 42
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7662
Country	:	US
Telephone Number	:	210-226-1362
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER NETWORK ADMINISTRATOR
Name	:	ERIC ANTOINE
Credential	:
Telephone Number	:	678-892-3771

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	02/24/2017

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