Provider Demographics
NPI:1811579592
Name:NATIONAL VISION INC
Entity Type:Organization
Organization Name:NATIONAL VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE SALES
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
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:678-892-3771
Mailing Address - Fax:
Practice Address - Street 1:675 DURBIN PAVILION DR STE 107
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4141
Practice Address - Country:US
Practice Address - Phone:904-417-9243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty