Provider Demographics
NPI:1386199602
Name:NATIONAL VISION, INC.
Entity Type:Organization
Organization Name:NATIONAL VISION, INC.
Other - Org Name:AM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:AULTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-822-4203
Mailing Address - Street 1:2435 COMMERCE AVE
Mailing Address - Street 2:BLDG 2200
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4980
Mailing Address - Country:US
Mailing Address - Phone:800-571-5202
Mailing Address - Fax:
Practice Address - Street 1:4501 S LABURNUM AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-2482
Practice Address - Country:US
Practice Address - Phone:804-591-4581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty