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	:	1992193221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL VISION, INC.

Provider Business Mailing Address
First Line	:	296 GRAYSON HWY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-5737
Country	:	US
Telephone Number	:	770-822-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	14223 FM 2920 RD
Second Line	:	STE 100
City	:	TOMBALL
State	:	TX
Zip	:	77377-5505
Country	:	US
Telephone Number	:	281-205-2290
Fax Number	:	281-255-0363

Authorized Official
Title or Position	:	MANAGED CARE SALES COORDINATOR
Name	:	LEAHANN VAUGHN
Credential	:
Telephone Number	:	470-448-2782

Provider Enumeration Date	:	01/09/2015
Last Update Date	:	01/09/2015

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