Provider Demographics
NPI:1205117975
Name:NOVA EYECARE CENTER, LLC
Entity type:Organization
Organization Name:NOVA EYECARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NHAN
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-274-7825
Mailing Address - Street 1:450 E TUDOR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7370
Mailing Address - Country:US
Mailing Address - Phone:907-274-7825
Mailing Address - Fax:907-274-7826
Practice Address - Street 1:2600 DENALI ST
Practice Address - Street 2:SUITE 603
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2746
Practice Address - Country:US
Practice Address - Phone:907-274-7825
Practice Address - Fax:907-274-7826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK206152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1577562Medicaid
AKU78994Medicare UPIN
AKK164169Medicare PIN