Provider Demographics
NPI:1164469516
Name:NATIONAL VISION, INC.
Entity Type:Organization
Organization Name:NATIONAL VISION, INC.
Other - Org Name:VISION CENTER BROUGHT TO YOU BY WALMART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE SALES COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEAHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-892-3760
Mailing Address - Street 1:296 GRAYSON HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-5737
Mailing Address - Country:US
Mailing Address - Phone:770-822-3600
Mailing Address - Fax:
Practice Address - Street 1:1800 CARL D SILVER PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4960
Practice Address - Country:US
Practice Address - Phone:540-786-8180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL VISION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009281444Medicaid
VA009281444Medicaid