Provider Demographics
NPI:1811650146
Name:NOVA VISION CARE, LLC
Entity type:Organization
Organization Name:NOVA VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTAMEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-241-0778
Mailing Address - Street 1:3048 SUGAR LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-6061
Mailing Address - Country:US
Mailing Address - Phone:703-241-0778
Mailing Address - Fax:
Practice Address - Street 1:444 W BROAD ST STE N
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3362
Practice Address - Country:US
Practice Address - Phone:703-241-0778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DMV VISION CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty