1073659132 NPI number — NATIONAL VISION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073659132 NPI number — NATIONAL VISION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL VISION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EYEGLASS WORLD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073659132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
296 GRAYSON HIGHWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-822-3600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8113 E. KELLOGG
Provider Second Line Business Practice Location Address:
SUITE #500
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-685-6861
Provider Business Practice Location Address Fax Number:
316-685-6018
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STEIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
SR. VICE PRESIDENT, PROFESSIONAL SE
Authorized Official Telephone Number:
770-822-3600

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  307895 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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