Provider Demographics
NPI:1396416954
Name:NATIONAL VISION INC
Entity Type:Organization
Organization Name:NATIONAL VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE STORE ENROLLEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-822-3600
Mailing Address - Street 1:2435 COMMERCE AVE
Mailing Address - Street 2:
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 1:18805 BEAR VALLEY RD STE 2
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-2728
Practice Address - Country:US
Practice Address - Phone:760-515-5131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty