Healthcare Provider Details

I. General information

NPI: 1659752392
Provider Name (Legal Business Name): NVA OF PA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 RITTER RD
MECHANICSBURG PA
17055-4879
US

IV. Provider business mailing address

5040 RITTER RD
MECHANICSBURG PA
17055-4879
US

V. Phone/Fax

Practice location:
  • Phone: 800-672-7723
  • Fax:
Mailing address:
  • Phone: 800-672-7723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD TERRANOVA
Title or Position: CFO
Credential:
Phone: 800-672-7723