Healthcare Provider Details

I. General information

NPI: 1487911855
Provider Name (Legal Business Name): HANOVER FAMILY EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7074 MECHANICSVILLE TPKE
MECHANICSVILLE VA
23111-3629
US

IV. Provider business mailing address

7074 MECHANICSVILLE TURNPIKE
MECHANICSVILLE VA
23111-4705
US

V. Phone/Fax

Practice location:
  • Phone: 804-746-5245
  • Fax: 804-559-7855
Mailing address:
  • Phone: 804-746-5245
  • Fax: 804-559-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001934
License Number StateVA

VIII. Authorized Official

Name: DR. RAJANISH SETTY
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 804-746-5245