Provider Demographics
NPI:1174652952
Name:NOVA EYE CARE INC
Entity Type:Organization
Organization Name:NOVA EYE CARE INC
Other - Org Name:NOVA EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:JANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-742-3777
Mailing Address - Street 1:17410 HIGHWAY 99
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3632
Mailing Address - Country:US
Mailing Address - Phone:425-742-3777
Mailing Address - Fax:425-742-8695
Practice Address - Street 1:17410 HIGHWAY 99
Practice Address - Street 2:SUITE 110
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3632
Practice Address - Country:US
Practice Address - Phone:425-742-3777
Practice Address - Fax:425-742-8695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2032191Medicaid
WA100000125710OtherREGENCE BLUESHIELD
WAG8864223Medicare PIN
WA100000125710OtherREGENCE BLUESHIELD