Basic Information
| Provider Information | |||||||||
| NPI: | 1508804550 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NATIONAL VISION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 296 GRAYSON HWY | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300465737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708223600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2424 CRATER LAKE HWY | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417790362 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 05/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | EDICK | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MC ASST. | ||||||||
| AuthorizedOfficialTelephone: | 6788923774 | ||||||||
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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) |
No ID Information.