Provider Demographics
NPI:1487911855
Name:HANOVER FAMILY EYECARE
Entity type:Organization
Organization Name:HANOVER FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SETTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-746-5245
Mailing Address - Street 1:7074 MECHANICSVILLE TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4705
Mailing Address - Country:US
Mailing Address - Phone:804-746-5245
Mailing Address - Fax:804-559-7855
Practice Address - Street 1:7074 MECHANICSVILLE TPKE
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3629
Practice Address - Country:US
Practice Address - Phone:804-746-5245
Practice Address - Fax:804-559-7855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB358Medicare PIN