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General NPI Number Information
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NPI Number | 1235536103
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Entity Type | Organization
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Legal Business Name | NOVA PREMIER EYECARE
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 10333 DEMOCRACY LN SUITE A
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City | FAIRFAX
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State | VA
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Zip | 22030-2544
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Country | US
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Telephone | 703-359-9290
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Fax |
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Provider Business Mailing Address
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Address Line | 10333 DEMOCRACY LN SUITE A
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City | FAIRFAX
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State | VA
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Zip | 22030-2544
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Country | US
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Telephone | 703-359-9290
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. VIVIAN HANG NGUYEN
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Credential |
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Telephone | 703-359-9290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618001480
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License Number State | VA
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