1225076128 NPI number — NATIONAL VISION, INC.

Table of content: (NPI 1225076128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225076128 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:
Provider Other Organization Name Type Code:
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:
1225076128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 951336
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75395-1336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5054 STATE HIGHWAY 23
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONEONTA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13820-3558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-433-4775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PURCELL
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER NETWORK ADMINISTRATOR
Authorized Official Telephone Number:
770-822-4245

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02735293 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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