Basic Information
Provider Information
NPI: 1467858530
EntityType: 2
ReplacementNPI:  
OrganizationName: NATIONAL VISION, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: AMERICA'S BEST CONTACTS & EYEGLASSES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 296 GRAYSON HWY
Address2:  
City: LAWRENCEVILLE
State: GA
PostalCode: 300465737
CountryCode: US
TelephoneNumber: 7708223600
FaxNumber:  
Practice Location
Address1: 5240 W MAIN ST
Address2:  
City: KALAMAZOO
State: MI
PostalCode: 49009
CountryCode: US
TelephoneNumber: 2692760035
FaxNumber: 2692769029
Other Information
ProviderEnumerationDate: 11/17/2014
LastUpdateDate: 11/17/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: VAUGHN
AuthorizedOfficialFirstName: LEAHANN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: MANAGED CARE SALES COORDINATOR
AuthorizedOfficialTelephone: 6788923760
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
156FX1800X  Y193400000X SINGLE SPECIALTY GROUPEye and Vision Services ProvidersTechnician/TechnologistOptician

No ID Information.


Home