Provider Demographics
NPI:1659327690
Name:NATIONAL VISION, INC.
Entity Type:Organization
Organization Name:NATIONAL VISION, INC.
Other - Org Name:VISION CENTER BROUGHT TO YOU BY WALMART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER NETWORK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEAHANN
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-448-2782
Mailing Address - Street 1:2435 COMMERCE AVE BLDG 2200
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:470-448-2782
Mailing Address - Fax:
Practice Address - Street 1:1510 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-2007
Practice Address - Country:US
Practice Address - Phone:970-522-9192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0630780303Medicare NSC