Provider Demographics
NPI:1235536103
Name:NOVA PREMIER EYECARE
Entity Type:Organization
Organization Name:NOVA PREMIER EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:HANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-359-9290
Mailing Address - Street 1:10333 DEMOCRACY LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2544
Mailing Address - Country:US
Mailing Address - Phone:703-359-9290
Mailing Address - Fax:
Practice Address - Street 1:10333 DEMOCRACY LN
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2544
Practice Address - Country:US
Practice Address - Phone:703-359-9290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty