Provider Demographics
NPI:1720780877
Name:NOVA ADVANCED EYECARE, PLLC
Entity type:Organization
Organization Name:NOVA ADVANCED EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-832-8650
Mailing Address - Street 1:13890 BRADDOCK RD STE 302
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2438
Mailing Address - Country:US
Mailing Address - Phone:571-832-8650
Mailing Address - Fax:571-832-8652
Practice Address - Street 1:13890 BRADDOCK RD STE 302
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2438
Practice Address - Country:US
Practice Address - Phone:571-832-8650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty