Provider Demographics
NPI:1437317369
Name:NOVACK OPTOMETRY INC
Entity Type:Organization
Organization Name:NOVACK OPTOMETRY INC
Other - Org Name:EASTLAND VISION CTR DR WILLIAM NOVACK OPTOMETRIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVACK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-478-0900
Mailing Address - Street 1:19049 EAST VALLEY VIEW PKWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055
Mailing Address - Country:US
Mailing Address - Phone:816-478-0900
Mailing Address - Fax:816-478-4229
Practice Address - Street 1:19049 EAST VALLEY VIEW PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:816-478-0900
Practice Address - Fax:816-478-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02231152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty