Provider Demographics
NPI:1427005917
Name:NATIONAL VISION, INC.
Entity Type:Organization
Organization Name:NATIONAL VISION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTOINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-892-3771
Mailing Address - Street 1:PO BOX 951336
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75395-1336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 TURNER ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2363
Practice Address - Country:US
Practice Address - Phone:910-695-0861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0630780255Medicare NSC