Provider Demographics
NPI:1417003138
Name:NATIONAL VISION, INC.
Entity Type:Organization
Organization Name:NATIONAL VISION, INC.
Other - Org Name:EYEGLASS WORLD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT, PROFESSIONAL SE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-822-3600
Mailing Address - Street 1:296 GRAYSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-822-3600
Mailing Address - Fax:
Practice Address - Street 1:5466 EAST STATE STREET
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108
Practice Address - Country:US
Practice Address - Phone:815-398-8703
Practice Address - Fax:815-398-2952
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL VISION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-26
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL200317665332H00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier