Provider Demographics
NPI:1649619511
Name:NATIONAL VISION OPTICAL
Entity type:Organization
Organization Name:NATIONAL VISION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
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 1:296 GRAYSON HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-5737
Mailing Address - Country:US
Mailing Address - Phone:800-571-5202
Mailing Address - Fax:
Practice Address - Street 1:7901 GIBSON BLVD
Practice Address - Street 2:BLDG 20176
Practice Address - City:KIRTLAND
Practice Address - State:NM
Practice Address - Zip Code:87117
Practice Address - Country:US
Practice Address - Phone:505-268-0015
Practice Address - Fax:505-767-7158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL VISION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-24
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty