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	:	1811498793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL VISION, INC.

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

Provider Business Practice Location Address
First Line	:	2117 N MAIN ST
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27262-7700
Country	:	US
Telephone Number	:	336-804-6125
Fax Number	:

Authorized Official
Title or Position	:	MANAGED CARE SALES COORDINATOR
Name	:	BRIAN MATOS
Credential	:
Telephone Number	:	678-892-3771

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	02/26/2018

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