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	:	1891249710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL VISION, INC.

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

Provider Business Practice Location Address
First Line	:	1801 14TH AVE SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-8502
Country	:	US
Telephone Number	:	541-223-0179
Fax Number	:	541-928-1035

Authorized Official
Title or Position	:	MANAGED CARE COORDINATOR
Name	:	LISA AULTMAN
Credential	:
Telephone Number	:	770-822-4203

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	08/09/2016

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