Basic Information
| Provider Information | |||||||||
| NPI: | 1154378453 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONAL VISION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 951336 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753951336 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 845 BLOWING ROCK BLVD | ||||||||
| Address2: | |||||||||
| City: | LENOIR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286453757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287572812 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | PURCELL | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER NETWORK ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7708224245 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
ID Information
| ID | Type | State | Issuer | Description | 8802078 | 05 | NC | MEDICAID |