Provider Demographics
NPI:1104051390
Name:NATIONAL VISION
Entity type:Organization
Organization Name:NATIONAL VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:518-587-0258
Mailing Address - Street 1:16 OLD GICK RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-9452
Mailing Address - Country:US
Mailing Address - Phone:518-587-0258
Mailing Address - Fax:518-583-3991
Practice Address - Street 1:16 OLD GICK RD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPGS
Practice Address - State:NY
Practice Address - Zip Code:12866-9452
Practice Address - Country:US
Practice Address - Phone:518-587-0258
Practice Address - Fax:518-583-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008386-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty