Basic Information
| Provider Information | |||||||||
| NPI: | 1366197345 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONAL VISION INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2435 COMMERCE AVE | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300964980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708223600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 W LOWRY LN STE 142 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405033030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594366632 | ||||||||
| FaxNumber: | 8592789187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2022 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | GARRISON | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGED CARE STORE ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 7708223600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.