Provider Demographics
NPI:1386698421
Name:NATIONAL VISION, INC.
Entity type:Organization
Organization Name:NATIONAL VISION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER NETWORK ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-822-4245
Mailing Address - Street 1:PO BOX 951336
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75395-1336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43843 STERLING HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7640
Practice Address - Country:US
Practice Address - Phone:907-260-3316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL VISON, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK0630780449Medicare ID - Type Unspecified