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	:	1982171104
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	:	470-448-2092
Fax Number	:	770-220-1969

Provider Business Practice Location Address
First Line	:	4571 E LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-2822
Country	:	US
Telephone Number	:	562-668-5313
Fax Number	:	562-494-3757

Authorized Official
Title or Position	:	MANAGED CARE SALES COORDINATOR
Name	:	GINA TAYLOR
Credential	:
Telephone Number	:	470-448-2092

Provider Enumeration Date	:	10/25/2018
Last Update Date	:	10/25/2018

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