Provider Demographics
NPI:1437229564
Name:NEW VISION OPTICAL INC.
Entity Type:Organization
Organization Name:NEW VISION OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:770-949-2020
Mailing Address - Street 1:3417 HIGHWAY 5 STE B
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2378
Mailing Address - Country:US
Mailing Address - Phone:770-949-2020
Mailing Address - Fax:770-942-8061
Practice Address - Street 1:3417 HIGHWAY 5 STE B
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2378
Practice Address - Country:US
Practice Address - Phone:770-949-2020
Practice Address - Fax:770-942-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA795156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Not Answered332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100702OtherAVESIS
GA5024970001Medicare ID - Type Unspecified